Healthcare Provider Details

I. General information

NPI: 1053661603
Provider Name (Legal Business Name): CORINNE HOUSTON CASE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 W COVELL BLVD
DAVIS CA
95616-5658
US

IV. Provider business mailing address

3307 HAYGROUND WAY
SACRAMENTO CA
95835-2461
US

V. Phone/Fax

Practice location:
  • Phone: 530-756-2364
  • Fax:
Mailing address:
  • Phone: 530-867-6613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA22390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: