Provider Demographics
NPI:1851372239
Name:HORODYSKY, ANDRIJ WALODYMYR (MD)
Entity Type:Individual
Prefix:
First Name:ANDRIJ
Middle Name:WALODYMYR
Last Name:HORODYSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7117 BROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2658
Mailing Address - Country:US
Mailing Address - Phone:951-782-3703
Mailing Address - Fax:951-784-3270
Practice Address - Street 1:7117 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2615
Practice Address - Country:US
Practice Address - Phone:951-782-3703
Practice Address - Fax:951-784-3270
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50670207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ31887ZOtherGROUP SITE NUMBER
ZZZ31887ZOtherGROUP SITE NUMBER
00A50670Medicare ID - Type Unspecified