Basic Information
Provider Information | |||||||||
NPI: | 1104989706 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOFFMAN | ||||||||
FirstName: | ROBERT | ||||||||
MiddleName: | STEVEN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 577 AIRPORT BLVD | ||||||||
Address2: | SUITE 300 | ||||||||
City: | BURLINGAME | ||||||||
State: | CA | ||||||||
PostalCode: | 940102020 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6502408198 | ||||||||
FaxNumber: | 4083285695 | ||||||||
Practice Location | |||||||||
Address1: | 1501 TROUSDALE DR | ||||||||
Address2: | 4TH FLOOR | ||||||||
City: | BURLINGAME | ||||||||
State: | CA | ||||||||
PostalCode: | 940104506 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6506528500 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/18/2006 | ||||||||
LastUpdateDate: | 04/23/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | G027114 | CA | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
ID | Type | State | Issuer | Description | GR0016181 | 05 | CA |   | MEDICAID |