Healthcare Provider Details

I. General information

NPI: 1801074034
Provider Name (Legal Business Name): RENDEL R HOUSTON MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44725 10TH ST W #170
LANCASTER CA
93534-3033
US

IV. Provider business mailing address

44725 10TH ST W #170
LANCASTER CA
93534-3033
US

V. Phone/Fax

Practice location:
  • Phone: 661-723-7886
  • Fax: 661-949-7746
Mailing address:
  • Phone: 661-723-7886
  • Fax: 661-949-7746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberG14956
License Number StateCA

VIII. Authorized Official

Name: MR. RENDEL R HOUSTON
Title or Position: OWNER
Credential: MD
Phone: 661-723-7886