Provider Demographics
NPI:1225591761
Name:HOUSTON, DOUGLAS
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1648 MAYBERRY CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3501
Mailing Address - Country:US
Mailing Address - Phone:707-423-3434
Mailing Address - Fax:707-437-1849
Practice Address - Street 1:101 BODIN CIR RM 4A404
Practice Address - Street 2:
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1802
Practice Address - Country:US
Practice Address - Phone:707-423-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR090000673RN163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management