MEDICARE: ANDREW GABRIEL HORODNER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	A81801	CA

General Provider Information

NPI Number	:	1386849974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW GABRIEL HORODNER M.D.

Provider Business Mailing Address
First Line	:	514 N PROSPECT AVE FL 4
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3040
Country	:	US
Telephone Number	:	310-750-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	514 N PROSPECT AVE FL 4
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3040
Country	:	US
Telephone Number	:	310-750-3300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	03/08/2017

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