Healthcare Provider Details

I. General information

NPI: 1447434105
Provider Name (Legal Business Name): MR. DARREN ALEX HOFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 NIZHONI BLVD
GALLUP NM
87301-5748
US

IV. Provider business mailing address

516 NIZHONI BLVD
GALLUP NM
87301-5748
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1254
  • Fax: 505-722-1487
Mailing address:
  • Phone: 505-722-1254
  • Fax: 505-722-1487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28133628A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: