Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | G10463 | CA |
NPI | 1902974363 |
---|---|
Provider Name | Monro Mark Hoffer |
First Address | Los Angeles, CA 90007-2629 |
Second Address | Los Angeles, CA 90007-2629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G104630 | (05) | CA |