Provider Demographics
NPI:1780902338
Name:HORNER, MELODY TANIS (CN)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:TANIS
Last Name:HORNER
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9104 SUMMERTIME LN
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4558
Mailing Address - Country:US
Mailing Address - Phone:310-559-7953
Mailing Address - Fax:
Practice Address - Street 1:9104 SUMMERTIME LN
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4558
Practice Address - Country:US
Practice Address - Phone:310-559-7953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist