Active NPI
Jerry W Horner II, HEALTH SERVICES TECH
- Other Technician
- Petaluma, CA
National Provider Identifier
1023158870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- Practice address
- 599 Tomale Rd
BLDG 125 Room 106
Petaluma, CA 94952 - Phone
- (707) 765-7524
- Fax
- (707) 765-7495
- NPI assigned
- Feb 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | DC | Primary |
Addresses
Primary practice location
599 Tomale Rd
BLDG 125 Room 106
Petaluma, CA 94952
Mailing address
404C Utah Dr
Petaluma, CA 94952
Phone (707) 765-7524
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 247200000X | DC | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023158870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "404C UTAH DR",
"city": "PETALUMA",
"state": "CA",
"postal_code": "94952",
"telephone_number": "707-765-7524",
"fax_number": "707-765-7495"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "599 TOMALE RD",
"address_2": "BLDG 125 ROOM 106",
"city": "PETALUMA",
"state": "CA",
"postal_code": "94952",
"telephone_number": "707-765-7524",
"fax_number": "707-765-7495"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HORNER",
"first_name": "JERRY",
"middle_name": "W",
"name_suffix": "II",
"credential": "HEALTH SERVICES TECH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "DC",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.