MEDICARE: JACOB MATHEUS HORN

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1598616906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB MATHEUS HORN

Provider Business Mailing Address
First Line	:	1935 ADDISON ST STE A
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94704-1354
Country	:	US
Telephone Number	:	831-888-4676
Fax Number	:

Provider Business Practice Location Address
First Line	:	4539 N 22ND ST STE R
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4639
Country	:	US
Telephone Number	:	831-888-4676
Fax Number	:

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

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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Directions to “ JACOB MATHEUS HORN ” Practice Location

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