Healthcare Provider Details

I. General information

NPI: 1083690127
Provider Name (Legal Business Name): BIOHORIZON MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3882 DEL AMO BOULEVARD 604
TORRANCE CA
90503-2184
US

IV. Provider business mailing address

3882 DEL AMO BLVD 604
TORRANCE CA
90503
US

V. Phone/Fax

Practice location:
  • Phone: 310-321-5830
  • Fax: 310-321-5428
Mailing address:
  • Phone: 310-321-5830
  • Fax: 310-321-5428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberHMDR #103712
License Number StateCA

VIII. Authorized Official

Name: MARK EDWARD KNIGHT
Title or Position: PRESIDENT
Credential:
Phone: 310-321-5830