Healthcare Provider Details

I. General information

NPI: 1629190384
Provider Name (Legal Business Name): IVONNE ELIZABETH HORTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 W LA CADENA DR
RIVERSIDE CA
92501-1413
US

IV. Provider business mailing address

43955 OLIVE AVE
HEMET CA
92544-2700
US

V. Phone/Fax

Practice location:
  • Phone: 951-784-8010
  • Fax:
Mailing address:
  • Phone: 951-275-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: