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NPI Code Detail

MEDICARE: JESSICA LYN HORAZY PA-C

MEDICARE: JESSICA LYN HORAZY PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant18647CA

General Provider Information

NPI Number : 1366653834
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LYN HORAZY PA-C
Provider Business Mailing Address
First Line : 6031 AGAPANTHUS PL
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-7201
Country : US
Telephone Number : 818-577-3253
Fax Number : 818-716-6480
Provider Business Practice Location Address
First Line : 5995 TOPANGA CANYON BLVD
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-3623
Country : US
Telephone Number : 818-888-7009
Fax Number : 818-888-7018
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2007
Last Update Date : 07/08/2007

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