Provider Demographics
NPI:1134101454
Name:HORST, ROBERT O (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:O
Last Name:HORST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 POWER INN RD STE 140
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3889
Mailing Address - Country:US
Mailing Address - Phone:916-875-1183
Mailing Address - Fax:916-875-6904
Practice Address - Street 1:3331 POWER INN RD STE 140
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3889
Practice Address - Country:US
Practice Address - Phone:916-875-1183
Practice Address - Fax:916-875-6904
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0823762084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A823760Medicaid
CAH99380Medicare UPIN