1255390183 NPI number — HANZELIK AND HORTON, MDS, INC.

Table of content: MRS. DIANE REBECCA HINDERAKER BA (NPI 1134472251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255390183 NPI number — HANZELIK AND HORTON, MDS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HANZELIK AND HORTON, MDS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255390183
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1240 S WESTLAKE BLVD
Provider Second Line Business Mailing Address:
SUITE 231
Provider Business Mailing Address City Name:
WESTLAKE VILLAGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91361-1929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-446-4444
Provider Business Mailing Address Fax Number:
805-497-4650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1240 WESTLAKE BLVD
Provider Second Line Business Practice Location Address:
SUITE 231
Provider Business Practice Location Address City Name:
WESTLAKE VILLAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91361-1929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-446-4444
Provider Business Practice Location Address Fax Number:
805-497-4650
Provider Enumeration Date:
03/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HANZELIK
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
SAM
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
805-446-4444

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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