Basic Information
| Provider Information | |||||||||
| NPI: | 1275038762 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOFFNER | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | TYLER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 997377 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958997377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165529940 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | HANSEN FAMILY HEALTH CENTER | ||||||||
| Address2: | 215 W BEAMER ST | ||||||||
| City: | WOODLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304052800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2018 | ||||||||
| LastUpdateDate: | 07/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | WV | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | CA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 272372291 | 01 | WV | BLUEFIELD HOSPITAL COMPANY, LLC | OTHER |