MEDICARE: ORLANDO DAMON HORTON

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
1	343900000X	Non-emergency Medical Transport (VAN)	6LJL900	CA

General Provider Information

NPI Number	:	1598435505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ORLANDO DAMON HORTON

Provider Business Mailing Address
First Line	:	6746 6TH AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-4408
Country	:	US
Telephone Number	:	323-898-1207
Fax Number	:

Provider Business Practice Location Address
First Line	:	6746 6TH AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-4408
Country	:	US
Telephone Number	:	323-898-1207
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2021
Last Update Date	:	09/20/2021

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