1881736320 NPI number — SUSAN HARTLEY HORIUCHI OD

Table of content: SUSAN HARTLEY HORIUCHI OD (NPI 1881736320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881736320 NPI number — SUSAN HARTLEY HORIUCHI OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORIUCHI
Provider First Name:
SUSAN
Provider Middle Name:
HARTLEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARTLEY
Provider Other First Name:
SUSAN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1881736320
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 PARK AVE STE 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAGUNA BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92651-2352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-494-2546
Provider Business Mailing Address Fax Number:
949-497-0010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 PARK AVE STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGUNA BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92651-2352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-494-2546
Provider Business Practice Location Address Fax Number:
949-497-0010
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  7484T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: SD0074840 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0180480001 . This is a "CMS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: OP7484 CA . This is a "MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0180480001 . This is a "DMERC REGION D" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0182880001 . This is a "MEDICARE NSC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com