Healthcare Provider Details

I. General information

NPI: 1205261872
Provider Name (Legal Business Name): CHANTELL MARIE HOFFMAN PA -C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHANTELL MARIE FUKUMAE

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 09/29/2024
Certification Date: 09/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 SW CEDAR HILLS BLVD
BEAVERTON OR
97005-1416
US

IV. Provider business mailing address

767 NE ADWICK DR
HILLSBORO OR
97006-9207
US

V. Phone/Fax

Practice location:
  • Phone: 503-352-6000
  • Fax:
Mailing address:
  • Phone: 808-206-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number222431
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: