Healthcare Provider Details

I. General information

NPI: 1558749986
Provider Name (Legal Business Name): PEARL DELANO HOUGHTELING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 02/11/2022
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 WELCH RD
PALO ALTO CA
94304-1614
US

IV. Provider business mailing address

453 QUARRY ROAD NEONATOLOGY: MAIL CODE 5660
PALO ALTO CA
94304
US

V. Phone/Fax

Practice location:
  • Phone: 650-497-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number162256
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number61075
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: