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General NPI Number Information
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NPI Number | 1386203073
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Entity Type | Organization
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Legal Business Name | C HOUSTON, INC
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Dates
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Enumeration Date | 06/07/2019
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Last Update Date | 07/02/2020
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Provider Practice Location Address
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Address Line | 4033 3RD AVE STE 400
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City | SAN DIEGO
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State | CA
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Zip | 92103-2140
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Country | US
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Telephone | 888-883-8658
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Fax | 888-606-1317
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Provider Business Mailing Address
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Address Line | 7459 BOOKHAM CT
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City | SAN DIEGO
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State | CA
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Zip | 92111-6734
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Country | US
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Telephone | 435-229-8321
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Fax |
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Authorized Official
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Title or Position | MD/PRESIDENT
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Name | DR. COLE JACKSON HOUSTON
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Credential | MD
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Telephone | 435-229-8321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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