Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 MACE BLVD STE J #285
DAVIS CA
95618
US

IV. Provider business mailing address

2050 LYNDELL TER SUITE 150
DAVIS CA
95616-6204
US

V. Phone/Fax

Practice location:
  • Phone: 530-400-3533
  • Fax: 530-758-2589
Mailing address:
  • Phone: 530-758-1563
  • Fax: 530-758-2589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG072518
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberG072518
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ELISA E HORTA
Title or Position: PRESIDENT
Credential: MD, MPH
Phone: 530-400-3533