Healthcare Provider Details

I. General information

NPI: 1962680272
Provider Name (Legal Business Name): LUZ RAQUEL HORN REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 W 17TH ST SUITE 101
SANTA ANA CA
92706-3455
US

IV. Provider business mailing address

1227 W 17TH ST SUITE 101
SANTA ANA CA
92706-3455
US

V. Phone/Fax

Practice location:
  • Phone: 714-500-0340
  • Fax: 714-500-0341
Mailing address:
  • Phone: 714-500-0340
  • Fax: 714-500-0341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number647446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: