Healthcare Provider Details

I. General information

NPI: 1154855484
Provider Name (Legal Business Name): AMANDA MARIE HONSVALL HOEFLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA MARIE HONSVALL M.D.

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 15TH ST STE 2100
SANTA MONICA CA
90404-1101
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-319-1234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA170105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: