Healthcare Provider Details

I. General information

NPI: 1518402056
Provider Name (Legal Business Name): DUSTIN V HOFHEINS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N RAINBOW BLVD STE 203
LAS VEGAS NV
89107-1084
US

IV. Provider business mailing address

1250 AMERICAN PACIFIC DR APT 1212
HENDERSON NV
89074-7858
US

V. Phone/Fax

Practice location:
  • Phone: 702-259-1228
  • Fax:
Mailing address:
  • Phone: 801-602-2831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0348
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: