Healthcare Provider Details

I. General information

NPI: 1699854943
Provider Name (Legal Business Name): STACEY LYNNE HOFFMANN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 FAIRVIEW LN SUITE A/B
SONORA CA
95370-4856
US

IV. Provider business mailing address

18701 TIFFENI DR SUITE 1A
TWAIN HARTE CA
95383-9406
US

V. Phone/Fax

Practice location:
  • Phone: 209-536-0600
  • Fax: 209-536-0604
Mailing address:
  • Phone: 209-586-1400
  • Fax: 209-586-6748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA62148
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: