Provider Demographics
NPI:1801201462
Name:HOOFFSTETTER, ROBERT ALLEN (IDC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:HOOFFSTETTER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 RENDOVA RD
Mailing Address - Street 2:SUITE 156
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92155-5041
Mailing Address - Country:US
Mailing Address - Phone:619-537-3232
Mailing Address - Fax:
Practice Address - Street 1:2424 RENDOVA RD
Practice Address - Street 2:SUITE 156
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92155-5041
Practice Address - Country:US
Practice Address - Phone:619-537-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman