Provider Demographics
NPI:1396792487
Name:HORNS, RICHARD COBURN (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:COBURN
Last Name:HORNS
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 1:1502 ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-5318
Mailing Address - Country:US
Mailing Address - Phone:909-593-4333
Mailing Address - Fax:909-593-5588
Practice Address - Street 1:8283 GROVE AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3137
Practice Address - Country:US
Practice Address - Phone:909-949-2242
Practice Address - Fax:909-920-9863
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37523174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47124Medicare UPIN
CAWG37523TMedicare ID - Type Unspecified