Provider Demographics
NPI:1902974363
Name:HOFFER, MONRO MARK (MD)
Entity Type:Individual
Prefix:
First Name:MONRO
Middle Name:MARK
Last Name:HOFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:M.
Other - Middle Name:MARK
Other - Last Name:HOFFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2400 S FLOWER ST
Mailing Address - Street 2:OHMG
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-2629
Mailing Address - Country:US
Mailing Address - Phone:213-742-6527
Mailing Address - Fax:213-742-1583
Practice Address - Street 1:2400 S FLOWER ST
Practice Address - Street 2:OHMG
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-2629
Practice Address - Country:US
Practice Address - Phone:213-742-6527
Practice Address - Fax:213-742-1583
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG10463207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G104630Medicaid