Provider Demographics
NPI:1801012489
Name:DEBORAH HORAK CRNA INC
Entity Type:Organization
Organization Name:DEBORAH HORAK CRNA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HORAK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:310-246-9004
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 1:416 N BEDFORD DR
Practice Address - Street 2:200
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4322
Practice Address - Country:US
Practice Address - Phone:909-946-5752
Practice Address - Fax:909-694-2370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA1830367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ51315ZOtherBLUE SHIELD
CAZZZ51315ZOtherBLUE SHIELD
CAZZZ51315ZOtherBLUE SHIELD