MEDICARE: DR. MARK KEVIN HOROWITZ DO

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	207N00000X	Dermatology Physician	20A7642	CA
2	207ND0101X	MOHS-Micrographic Surgery Physician	20A7642	CA
3	207ND0900X	Dermatopathology Physician	20A7642	CA
4	207NI0002X	Clinical & Laboratory Dermatological Immunology Physician	20A7642	CA
5	207NP0225X	Pediatric Dermatology Physician	20A7642	CA
6	207NS0135X	Procedural Dermatology Physician	20A7642	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20A7642	OTHER	CA	OSTEOPATHIC MEDICAL BOARD

General Provider Information

NPI Number	:	1669413878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK KEVIN HOROWITZ DO

Provider Business Mailing Address
First Line	:	23550 HAWTHORNE BLVD.
Second Line	:	#200
City	:	TORRANCE
State	:	CA
Zip	:	90505-4722
Country	:	US
Telephone Number	:	310-534-9131
Fax Number	:	310-534-9132

Provider Business Practice Location Address
First Line	:	23550 HAWTHORNE BLVD STE 200
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90505-4722
Country	:	US
Telephone Number	:	310-373-2636
Fax Number	:

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	01/17/2014

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