Provider Demographics
NPI:1255390183
Name:HANZELIK AND HORTON, MDS, INC.
Entity type:Organization
Organization Name:HANZELIK AND HORTON, MDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:SAM
Authorized Official - Last Name:HANZELIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-446-4444
Mailing Address - Street 1:1240 S WESTLAKE BLVD
Mailing Address - Street 2:SUITE 231
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1929
Mailing Address - Country:US
Mailing Address - Phone:805-446-4444
Mailing Address - Fax:805-497-4650
Practice Address - Street 1:1240 WESTLAKE BLVD
Practice Address - Street 2:SUITE 231
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-1929
Practice Address - Country:US
Practice Address - Phone:805-446-4444
Practice Address - Fax:805-497-4650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13851Medicare ID - Type Unspecified