Healthcare Provider Details

I. General information

NPI: 1538142575
Provider Name (Legal Business Name): MIRIAM G HOPFENBLATT LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6973 LINDA VISTA ROAD
SAN DIEGO CA
92111-6339
US

IV. Provider business mailing address

6973 LINDA VISTA ROAD
SAN DIEGO CA
92111-6339
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-9676
  • Fax: 858-279-0377
Mailing address:
  • Phone: 858-279-9676
  • Fax: 858-279-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN81807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: