Provider Demographics
NPI:1821372871
Name:HORAN, AMY (OPA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HORAN
Suffix:
Gender:F
Credentials:OPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-5127
Mailing Address - Country:US
Mailing Address - Phone:607-661-0182
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL DR STE 303
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2583
Practice Address - Country:US
Practice Address - Phone:707-645-7210
Practice Address - Fax:707-645-7249
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1161174400000X
NY18634363A00000X
CA52433363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No174400000XOther Service ProvidersSpecialist