Healthcare Provider Details

I. General information

NPI: 1477084580
Provider Name (Legal Business Name): TREVOR PATRICK HOUSTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 POSADA LN STE 202
TEMPLETON CA
93465-4060
US

IV. Provider business mailing address

1701 W CHARLESTON BLVD STE 230
LAS VEGAS NV
89102-2312
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-5530
  • Fax: 805-434-0023
Mailing address:
  • Phone: 702-671-2341
  • Fax: 702-671-2376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0548309
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number20A25134
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: