Individual
JERRY DEWAYNE HOUSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
11201 BENTON ST, LOMA LINDA, CA 92357-1000
(909) 825-7084
Mailing address
11201 BENTON ST, LOMA LINDA, CA 92357-1000
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
198830
CA
Other
Enumeration date
09/17/2008
Last updated
09/17/2008
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