Provider Demographics
NPI:1083196562
Name:C P G
Entity Type:Organization
Organization Name:C P G
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:323-488-0039
Mailing Address - Street 1:2635 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5709
Mailing Address - Country:US
Mailing Address - Phone:323-488-0039
Mailing Address - Fax:323-433-9177
Practice Address - Street 1:2635 WALNUT ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5709
Practice Address - Country:US
Practice Address - Phone:323-488-0039
Practice Address - Fax:323-433-9177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-31
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty