Provider Demographics
NPI:1013132596
Name:HOUSTON, CARON ALEXANDRA (MD)
Entity type:Individual
Prefix:
First Name:CARON
Middle Name:ALEXANDRA
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 MANZANITA AVE # 6-234
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-1770
Mailing Address - Country:US
Mailing Address - Phone:916-245-6464
Mailing Address - Fax:916-339-6455
Practice Address - Street 1:4005 MANZANITA AVE # 6-234
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-1770
Practice Address - Country:US
Practice Address - Phone:916-731-7965
Practice Address - Fax:916-731-7936
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231187207R00000X
CAC52967207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY231187OtherMEDICAL LICENSE
NY231187OtherMEDICAL LICENSE