Provider Demographics
NPI:1992989404
Name:HORNING, DWIGHT LLOYD (PHN)
Entity type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:LLOYD
Last Name:HORNING
Suffix:
Gender:M
Credentials:PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 SCENIC DRIVE
Mailing Address - Street 2:BUILDING 3
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95353-3127
Mailing Address - Country:US
Mailing Address - Phone:209-558-8831
Mailing Address - Fax:209-558-8315
Practice Address - Street 1:830 SCENIC DRIVE
Practice Address - Street 2:BUILDING 3
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95353-3127
Practice Address - Country:US
Practice Address - Phone:209-558-8831
Practice Address - Fax:209-558-8315
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392051171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator