Healthcare Provider Details

I. General information

NPI: 1023002151
Provider Name (Legal Business Name): MARIA WILLIAMSON HOUSE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2005
Last Update Date: 02/19/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MISSION BLVD STE B116
JACKSON CA
95642-2536
US

IV. Provider business mailing address

10560 RIDGECREST DR
JACKSON CA
95642-9348
US

V. Phone/Fax

Practice location:
  • Phone: 209-217-8416
  • Fax: 209-217-8433
Mailing address:
  • Phone: 719-648-3595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number148178
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301099492
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number4301099492
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number38764
License Number StateCO
# 5
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number148178
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: