Provider Demographics
NPI:1699854943
Name:HOFFMANN, STACEY LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:LYNNE
Last Name:HOFFMANN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:18701 TIFFENI DR
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:TWAIN HARTE
Mailing Address - State:CA
Mailing Address - Zip Code:95383-9406
Mailing Address - Country:US
Mailing Address - Phone:209-586-1400
Mailing Address - Fax:209-586-6748
Practice Address - Street 1:183 FAIRVIEW LN
Practice Address - Street 2:SUITE A/B
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4856
Practice Address - Country:US
Practice Address - Phone:209-536-0600
Practice Address - Fax:209-536-0604
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2010-11-05
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Provider Licenses
StateLicense IDTaxonomies
CAA62148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A621481Medicare PIN