Provider Demographics
NPI:1447451935
Name:HOFELING, TODD JAY (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:JAY
Last Name:HOFELING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:707-521-7799
Mailing Address - Fax:707-573-5429
Practice Address - Street 1:3883 AIRWAY DR STE 130
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403
Practice Address - Country:US
Practice Address - Phone:707-521-7799
Practice Address - Fax:707-573-5429
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ76487207R00000X
AZ70347207RR0500X
CAA112651207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA112651OtherSTATE MEDICAL LICENSE
CAFH2028719OtherFEDERAL DEA LICENSE