Healthcare Provider Details

I. General information

NPI: 1497438386
Provider Name (Legal Business Name): MAAME-MENSIMA HORNE ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10474 SANTA MONICA BLVD STE 305
LOS ANGELES CA
90025-6931
US

IV. Provider business mailing address

1535 HARVARD ST APT D
SANTA MONICA CA
90404-5561
US

V. Phone/Fax

Practice location:
  • Phone: 310-596-5480
  • Fax:
Mailing address:
  • Phone: 480-696-9586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1527
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227.022863
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: