Provider Demographics
NPI:1487914115
Name:HOGAN, GEORGE EDWARD JR
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:EDWARD
Last Name:HOGAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1688 N PERRIS BLVD STE L7-L11
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-4709
Mailing Address - Country:US
Mailing Address - Phone:951-443-2200
Mailing Address - Fax:951-443-2230
Practice Address - Street 1:1688 N PERRIS BLVD STE L7-L11
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-4709
Practice Address - Country:US
Practice Address - Phone:951-443-2200
Practice Address - Fax:951-443-2230
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator