Provider Demographics
NPI:1164637435
Name:HOUTERMAN, ANNA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:HOUTERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:KAMINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:24302 PASEO DE VALENCIA STE 201
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3115
Mailing Address - Country:US
Mailing Address - Phone:949-598-1701
Mailing Address - Fax:949-598-1711
Practice Address - Street 1:24302 PASEO DE VALENCIA STE 201
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3115
Practice Address - Country:US
Practice Address - Phone:949-598-1701
Practice Address - Fax:949-598-1711
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86277208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA86277OtherMEDICAL LICENSE
CACB231350OtherMEDICARE PTAN