Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1639671290 |
---|---|
Provider Name | Matt Hoffer |
First Address | Redding, CA 96001-1809 |
Second Address | Redding, CA 96001-1809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2018 |
Last Update Date | 24/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GFC000180 | (05) | CA |
PG0073849001 | BLUE SHIELD OF CA (01) | CA |