Provider Demographics
NPI:1992051791
Name:LANGHORNE, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:LANGHORNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1685
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-1685
Mailing Address - Country:US
Mailing Address - Phone:951-990-3286
Mailing Address - Fax:
Practice Address - Street 1:39155 LIBERTY ST
Practice Address - Street 2:SUITE E500
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1513
Practice Address - Country:US
Practice Address - Phone:951-990-3286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program