Provider Demographics
NPI:1649020785
Name:HOROSCHAK, JESSICA SOPHIE
Entity type:Individual
Prefix:DR
First Name:JESSICA SOPHIE
Middle Name:
Last Name:HOROSCHAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA-SOPHIE
Other - Middle Name:
Other - Last Name:HOROSCHAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:400 N PEPPER AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 NORTH PEPPER AVE.
Practice Address - Street 2:STE 206, MOB
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324
Practice Address - Country:US
Practice Address - Phone:909-580-2159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program