MEDICARE: ELISA E HORTA, MD,MPH, A PROFESSIONAL MEDICAL CORPORATION

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	207Q00000X	Family Medicine Physician	G072518	CA
2	207VX0000X	Obstetrics Physician	G072518	CA
3	207VX0000X	Obstetrics Physician
4	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1942294285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELISA E HORTA, MD,MPH, A PROFESSIONAL MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	2050 LYNDELL TER
Second Line	:	SUITE 150
City	:	DAVIS
State	:	CA
Zip	:	95616-6204
Country	:	US
Telephone Number	:	530-758-1563
Fax Number	:	530-758-2589

Provider Business Practice Location Address
First Line	:	17 MACE BLVD STE J #285
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95618
Country	:	US
Telephone Number	:	530-400-3533
Fax Number	:	530-758-2589

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ELISA E HORTA
Credential	:	MD, MPH
Telephone Number	:	530-400-3533

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	06/08/2023

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