MEDICARE: SHANNON MARIE HORNE

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1881322162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON MARIE HORNE

Provider Business Mailing Address
First Line	:	6160 HOTEL CIRLCE NORTH
Second Line	:	SUITE 101
City	:	SAN DIEGO
State	:	CA
Zip	:	92108
Country	:	US
Telephone Number	:	619-320-2404
Fax Number	:

Provider Business Practice Location Address
First Line	:	6160 HOTEL CIRLCE NORTH
Second Line	:	SUITE 101
City	:	SAN DIEGO
State	:	CA
Zip	:	92108
Country	:	US
Telephone Number	:	619-320-2404
Fax Number	:

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

Provider Enumeration Date	:	08/12/2022
Last Update Date	:	09/19/2022

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