MEDICARE: MARK HOROWITZ DO, INC.

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	207NI0002X	Clinical & Laboratory Dermatological Immunology Physician	20A7642	CA
2	207ND0900X	Dermatopathology Physician	20A7642	CA
3	207ND0101X	MOHS-Micrographic Surgery Physician	20A7642	CA
4	207NP0225X	Pediatric Dermatology Physician	20A7642	CA
5	207NS0135X	Procedural Dermatology Physician	20A7642	CA
6	207N00000X	Dermatology Physician	20A7642	CA

General Provider Information

NPI Number	:	1952497414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK HOROWITZ DO, INC.

Provider Business Mailing Address
First Line	:	3521 LOMITA BLVD STE 103
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90505-5041
Country	:	US
Telephone Number	:	310-534-9131
Fax Number	:	310-534-9132

Provider Business Practice Location Address
First Line	:	23550 HAWTHORNE BLVD STE 200
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90505-4722
Country	:	US
Telephone Number	:	310-373-2636
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK HOROWITZ
Credential	:	DO
Telephone Number	:	310-373-2636

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	05/23/2011

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