Provider Demographics
NPI:1255163754
Name:HORTON, HANNAH MARIE (MS, RDN)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:MARIE
Last Name:HORTON
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 COVENTRY LN # 263
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2953
Mailing Address - Country:US
Mailing Address - Phone:916-798-6021
Mailing Address - Fax:
Practice Address - Street 1:170 PLACEMARK
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-0172
Practice Address - Country:US
Practice Address - Phone:916-798-6021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT90742133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered