Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 1234 | CO |
NPI | 1003403619 |
---|---|
Provider Name | Thia Janai Hoffman |
First Address | Arvada, CO 80003-2528 |
Second Address | Arvada, CO 80003-2528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2020 |
Last Update Date | 29/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1234 | N/A (01) | CO |