=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285130138
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOFFNER PASCUA DDS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2018
-----------------------------------------------------
Last Update Date | 03/31/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 WILLOW ST STE 100
-----------------------------------------------------
City | BONITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91902-1349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-482-9700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 145 WILLOW ST STE 100
-----------------------------------------------------
City | BONITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91902-1349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-482-9700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HOFFNER J. PASCUA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 858-336-5937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 55481
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------