Healthcare Provider Details

I. General information

NPI: 1588620058
Provider Name (Legal Business Name): WILLIAM A. VANHORN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9340 E STOCKTON BLVD
ELK GROVE CA
95624-1563
US

IV. Provider business mailing address

333 CROWN POINT CIR STE 125
GRASS VALLEY CA
95945-9538
US

V. Phone/Fax

Practice location:
  • Phone: 916-509-8198
  • Fax:
Mailing address:
  • Phone: 530-273-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG75572
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number2014-00886
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2014-00886
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: