Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | A170105 | CA |
NPI | 1154855484 |
---|---|
Provider Name | Amanda Marie Honsvall Hoefler |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Santa Monica, CA 90404-1101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2017 |
Last Update Date | 04/03/2021 |