Provider Demographics
NPI:1164558706
Name:RICHARD L. HOFFMAN, M.D., A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:RICHARD L. HOFFMAN, M.D., A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-273-0943
Mailing Address - Street 1:701 N CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3331
Mailing Address - Country:US
Mailing Address - Phone:310-273-0943
Mailing Address - Fax:310-273-4359
Practice Address - Street 1:201 S ALVARADO ST
Practice Address - Street 2:SUITE 828
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2320
Practice Address - Country:US
Practice Address - Phone:310-273-0943
Practice Address - Fax:310-273-4359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC28338207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACT829AOtherMEDICARE PTAN
MEDICARE RAILROADOther111986055
CAA33597Medicare UPIN
MEDICARE RAILROADOther111986055
CACT829AOtherMEDICARE PTAN