Individual
LAMONT WALLACE HORNBECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
729 SUNRISE AVE, SUITE 700, ROSEVILLE, CA 95661-4565
(916) 782-3721
(916) 782-0618
Mailing address
729 SUNRISE AVE, SUITE 700, ROSEVILLE, CA 95661-4565
(916) 782-3721
(916) 782-0618
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
G0517340
CA
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
G0517340
CA
207NS0135X
Procedural Dermatology Physician
Primary
G0517340
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G517340
—
CA
Enumeration date
07/02/2006
Last updated
09/11/2025
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