Provider Demographics
NPI:1023733946
Name:HOFER, CAMERON MICHAEL (DPT)
Entity type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:MICHAEL
Last Name:HOFER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 N SOLDANO AVE
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-3640
Mailing Address - Country:US
Mailing Address - Phone:503-547-9407
Mailing Address - Fax:
Practice Address - Street 1:801 S RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3223
Practice Address - Country:US
Practice Address - Phone:626-356-0599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist