Provider Demographics
NPI:1407933104
Name:HORAK, DEBORAH A (CRNA)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:A
Last Name:HORAK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1597
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-1597
Mailing Address - Country:US
Mailing Address - Phone:909-946-5752
Mailing Address - Fax:909-694-2370
Practice Address - Street 1:1658 MALCOLM AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5708
Practice Address - Country:US
Practice Address - Phone:909-946-5752
Practice Address - Fax:909-694-2370
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA1830367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ51315ZOtherBLUE SHIELD
CANA1830AMedicare ID - Type Unspecified
CACC096ZMedicare PIN