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General NPI Number Information
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NPI Number | 1659454593
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Entity Type | Organization
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Legal Business Name | PACIFIC HORIZON MEDICAL GROUP INC.
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2351 CLAY ST SUITE 512
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City | SAN FRANCISCO
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State | CA
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Zip | 94115-1931
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Country | US
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Telephone | 415-292-5477
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Fax | 415-292-5490
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Provider Business Mailing Address
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Address Line | 2351 CLAY ST SUITE 512
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City | SAN FRANCISCO
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State | CA
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Zip | 94115-1931
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Country | US
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Telephone | 415-292-5477
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Fax | 415-292-5490
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Authorized Official
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Title or Position | PRESIDENT
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Name | LORNA MARIE THORNTON
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Credential | M.D.
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Telephone | 415-292-5484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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