MEDICARE: HOFMEISTER MEDICAL, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1235755299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOFMEISTER MEDICAL, PC

Provider Business Mailing Address
First Line	:	31735 RIVERSIDE DR STE K
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-7816
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	31735 RIVERSIDE DR STE K
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-7816
Country	:	US
Telephone Number	:	951-245-2333
Fax Number	:

Authorized Official
Title or Position	:	EMPLOYEE
Name	:	PATRICK CONNOLLY
Credential	:
Telephone Number	:	951-245-2333

Provider Enumeration Date	:	06/24/2020
Last Update Date	:	06/24/2020

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