Provider Demographics
NPI:1629219027
Name:HORTON, MICHAEL JOHN (RN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:HORTON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 ROSECRANS ST
Mailing Address - Street 2:SUITE 128
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3134
Mailing Address - Country:US
Mailing Address - Phone:619-692-5699
Mailing Address - Fax:619-692-5650
Practice Address - Street 1:3851 ROSECRANS ST
Practice Address - Street 2:SUITE 128
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3134
Practice Address - Country:US
Practice Address - Phone:619-692-5699
Practice Address - Fax:619-692-5650
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA591336163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse