Healthcare Provider Details

I. General information

NPI: 1053670596
Provider Name (Legal Business Name): ROBERT HOUGHTON, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 1ST AVE STE. 200B
SAN DIEGO CA
92101-2685
US

IV. Provider business mailing address

1855 1ST AVE STE. 200B
SAN DIEGO CA
92101-2685
US

V. Phone/Fax

Practice location:
  • Phone: 619-233-4044
  • Fax:
Mailing address:
  • Phone: 619-233-4044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA49774
License Number StateCA

VIII. Authorized Official

Name: CHRIS BOBRITCHI
Title or Position: OFFICE MANAGER
Credential:
Phone: 619-233-4044