Provider Demographics
NPI:1831812692
Name:HORUS MULTISPECIALITY MEDICAL GROUP
Entity type:Organization
Organization Name:HORUS MULTISPECIALITY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-210-5141
Mailing Address - Street 1:5220 CLARK AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2641
Mailing Address - Country:US
Mailing Address - Phone:562-210-5141
Mailing Address - Fax:562-210-5127
Practice Address - Street 1:5220 CLARK AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2641
Practice Address - Country:US
Practice Address - Phone:562-210-5141
Practice Address - Fax:562-210-5127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty