Provider Demographics
NPI:1942294285
Name:ELISA E HORTA, MD,MPH, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ELISA E HORTA, MD,MPH, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HORTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:530-400-3533
Mailing Address - Street 1:2050 LYNDELL TER
Mailing Address - Street 2:SUITE 150
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-6204
Mailing Address - Country:US
Mailing Address - Phone:530-758-1563
Mailing Address - Fax:530-758-2589
Practice Address - Street 1:17 MACE BLVD STE J #285
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618
Practice Address - Country:US
Practice Address - Phone:530-400-3533
Practice Address - Fax:530-758-2589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG072518207Q00000X, 207VX0000X
207Q00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty