Healthcare Provider Details

I. General information

NPI: 1932447497
Provider Name (Legal Business Name): JESSICA DOTY HOFFMAN RD, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 148TH AVE NE
BELLEVUE WA
98007-7114
US

IV. Provider business mailing address

34030 SE STROUF ST
SNOQUALMIE WA
98065-8735
US

V. Phone/Fax

Practice location:
  • Phone: 425-202-6041
  • Fax:
Mailing address:
  • Phone: 425-231-8376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI 60314212
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: