Provider Demographics
NPI:1528591591
Name:PENTHOUSE PHYSICIANS GROUP, INC.
Entity Type:Organization
Organization Name:PENTHOUSE PHYSICIANS GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HOEFFLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-998-7792
Mailing Address - Street 1:8929 WILSHIRE BLVD
Mailing Address - Street 2:PENTHOUSE SUITE
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1938
Mailing Address - Country:US
Mailing Address - Phone:310-273-5100
Mailing Address - Fax:
Practice Address - Street 1:8929 WILSHIRE BLVD
Practice Address - Street 2:PENTHOUSE SUITE
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1938
Practice Address - Country:US
Practice Address - Phone:310-273-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74133261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical