Basic Information
Provider Information | |||||||||
NPI: | 1245355759 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOUSSIERE | ||||||||
FirstName: | DANIEL | ||||||||
MiddleName: | DAVID | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HOUSSIERE | ||||||||
OtherFirstName: | DANIEL | ||||||||
OtherMiddleName: | DAVID | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | DO | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 9961 SIERRA AVE | ||||||||
Address2: |   | ||||||||
City: | FONTANA | ||||||||
State: | CA | ||||||||
PostalCode: | 923356720 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9094273910 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 300 W HUNTINGTON DR | ||||||||
Address2: |   | ||||||||
City: | ARCADIA | ||||||||
State: | CA | ||||||||
PostalCode: | 910073402 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6268988000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/21/2007 | ||||||||
LastUpdateDate: | 01/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/22/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 20A4796 | CA | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
No ID Information.