Provider Demographics
NPI:1902839053
Name:HORVATH, DAGMAR MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:DAGMAR
Middle Name:MARIA
Last Name:HORVATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 SAMARITAN DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4104
Mailing Address - Country:US
Mailing Address - Phone:408-295-8988
Mailing Address - Fax:408-295-8731
Practice Address - Street 1:2550 SAMARITAN DR
Practice Address - Street 2:SUITE A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4104
Practice Address - Country:US
Practice Address - Phone:408-295-8988
Practice Address - Fax:408-295-8731
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25261305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA25261OtherMEDICAL LICENSE
CA00A252610Medicare UPIN
CAA25261OtherMEDICAL LICENSE