Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | PT16520 | CA |
NPI | 1689615106 |
---|---|
Provider Name | John R Horsley |
First Address | Fountain Valley, CA 92728-8125 |
Second Address | Mountain View, CA 94043-1444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 01/06/2012 |