Provider Demographics
NPI:1932674777
Name:HOYT, JUSTIN EUGENE
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:EUGENE
Last Name:HOYT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 N SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-2378
Mailing Address - Country:US
Mailing Address - Phone:541-991-8735
Mailing Address - Fax:
Practice Address - Street 1:801 S GRAND AVE STE 475
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4622
Practice Address - Country:US
Practice Address - Phone:310-871-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201808907NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health