Healthcare Provider Details

I. General information

NPI: 1225714793
Provider Name (Legal Business Name): SAMANTHA HOFFHINES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31565 RANCHO PUEBLO RD STE 201
TEMECULA CA
92592-4839
US

IV. Provider business mailing address

31565 RANCHO PUEBLO RD STE 201
TEMECULA CA
92592-4839
US

V. Phone/Fax

Practice location:
  • Phone: 405-838-7068
  • Fax:
Mailing address:
  • Phone: 405-838-7068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95022570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: