Provider Demographics
NPI:1558422717
Name:HORAN, KATHLEEN L (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:L
Last Name:HORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:707-541-7700
Mailing Address - Fax:707-573-5415
Practice Address - Street 1:131 STONY CIR STE 1600
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-9520
Practice Address - Country:US
Practice Address - Phone:707-541-7700
Practice Address - Fax:707-573-5415
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG35154OtherSTATE MEDICAL LICENSE
CAAH7720926OtherFEDERAL DEA LICENSE
CAGR0068710OtherMCAL GROUP
CAG35154OtherMEDICAL LICENSE
CA00G351540Medicare ID - Type UnspecifiedPPIN
CAGR0068710OtherMCAL GROUP