Provider Demographics
NPI:1316938814
Name:HODGE, AMIR (NP)
Entity type:Individual
Prefix:
First Name:AMIR
Middle Name:
Last Name:HODGE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:68860 PEREZ RD
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-7249
Mailing Address - Country:US
Mailing Address - Phone:760-328-4499
Mailing Address - Fax:760-320-2725
Practice Address - Street 1:68860 PEREZ RD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-7249
Practice Address - Country:US
Practice Address - Phone:760-328-4499
Practice Address - Fax:760-320-2725
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP15114363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ36859Medicare UPIN
CAZZZ32756ZMedicare ID - Type Unspecified