Healthcare Provider Details

I. General information

NPI: 1164003828
Provider Name (Legal Business Name): STACEY MCCANN HOFFMAYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

1244 ALEXANDRIA DR
SAN DIEGO CA
92107-3935
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-8111
  • Fax:
Mailing address:
  • Phone: 415-812-1460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number684739
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number684739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: