Healthcare Provider Details

I. General information

NPI: 1821372871
Provider Name (Legal Business Name): AMY HORAN OPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL DR STE 303
VALLEJO CA
94589-2583
US

IV. Provider business mailing address

1248 BELMONT AVE
SAN CARLOS CA
94070-5127
US

V. Phone/Fax

Practice location:
  • Phone: 707-645-7210
  • Fax: 707-645-7249
Mailing address:
  • Phone: 607-661-0182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1161
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number18634
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number52433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: