Basic Information
| Provider Information | |||||||||
| NPI: | 1558353920 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HORTON | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | DELL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HORTON-KILBURN | ||||||||
| OtherFirstName: | CINDY | ||||||||
| OtherMiddleName: | DELL | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 337 | ||||||||
| Address2: | |||||||||
| City: | WAIMEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967960337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083389431 | ||||||||
| FaxNumber: | 8083389420 | ||||||||
| Practice Location | |||||||||
| Address1: | 4346 WAIMEA CANYON DRIVE | ||||||||
| Address2: | |||||||||
| City: | WAIMEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967960337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083389431 | ||||||||
| FaxNumber: | 8083389420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2005 | ||||||||
| LastUpdateDate: | 12/30/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD23104 | OR | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD00031832 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8157737 | 05 | WA | MEDICAID | 080170616 | 01 | WA | PTAN | OTHER |