Provider Demographics
NPI:1982762787
Name:HOFFMAN, THEODORE (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1792 TRIBUTE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4305
Mailing Address - Country:US
Mailing Address - Phone:916-924-6400
Mailing Address - Fax:
Practice Address - Street 1:1792 TRIBUTE RD
Practice Address - Street 2:SUITE 350
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4305
Practice Address - Country:US
Practice Address - Phone:916-924-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA248492084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000810837378OtherPHCS
CA90099280OtherPACIFICARE
CA00A248490Medicaid
CA24101OtherINTERPLAN
CAA24849OtherBLUE CROSS
CA5717779OtherFIRST HEALTH
CA3835OtherFIRST HEALTH
CA426748OtherGREAT WEST
CAMCMG379500OtherWESTERN HEALTH ADVANTAGE
CA5180106OtherAETNA
CAMCMG379500OtherWESTERN HEALTH ADVANTAGE
CA5717779OtherFIRST HEALTH