Healthcare Provider Details

I. General information

NPI: 1790777381
Provider Name (Legal Business Name): SANDRA GAIL HORWITZ O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14714 HAWTHORNE BLVD
LAWNDALE CA
90260-1523
US

IV. Provider business mailing address

14714 HAWTHORNE BLVD
LAWNDALE CA
90260-1523
US

V. Phone/Fax

Practice location:
  • Phone: 310-644-0368
  • Fax: 310-644-9984
Mailing address:
  • Phone: 310-644-0368
  • Fax: 310-644-9984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6694TPL
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: