Provider Demographics
NPI:1629634316
Name:HOFELICH, HEIDI A (LAC)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:A
Last Name:HOFELICH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5949 MADRA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3954
Mailing Address - Country:US
Mailing Address - Phone:808-557-5349
Mailing Address - Fax:
Practice Address - Street 1:3636 FIFTH AVE STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4230
Practice Address - Country:US
Practice Address - Phone:619-814-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18416171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty