Basic Information
| Provider Information | |||||||||
| NPI: | 1982762787 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOFFMAN | ||||||||
| FirstName: | THEODORE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1792 TRIBUTE RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958154305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169246400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1792 TRIBUTE RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958154305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169246400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 02/17/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | A24849 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 000810837378 | 01 | CA | PHCS | OTHER | 90099280 | 01 | CA | PACIFICARE | OTHER | 00A248490 | 05 | CA | MEDICAID | 24101 | 01 | CA | INTERPLAN | OTHER | A24849 | 01 | CA | BLUE CROSS | OTHER | 5717779 | 01 | CA | FIRST HEALTH | OTHER | 3835 | 01 | CA | FIRST HEALTH | OTHER | 426748 | 01 | CA | GREAT WEST | OTHER | MCMG379500 | 01 | CA | WESTERN HEALTH ADVANTAGE | OTHER | 5180106 | 01 | CA | AETNA | OTHER |