Provider Demographics
NPI:1487633822
Name:VON HOFFMANN, MARY T (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:T
Last Name:VON HOFFMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16300 SAND CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3706
Mailing Address - Country:US
Mailing Address - Phone:949-753-1001
Mailing Address - Fax:949-753-1115
Practice Address - Street 1:16300 SAND CANYON AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3711
Practice Address - Country:US
Practice Address - Phone:949-753-1001
Practice Address - Fax:949-753-1115
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60258174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE66279Medicare UPIN
CAG60258BMedicare PIN