Provider Demographics
NPI:1811148497
Name:HOUGH, JOHN ALLEN (PCA/LVN/LPN)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALLEN
Last Name:HOUGH
Suffix:
Gender:M
Credentials:PCA/LVN/LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 FAIRVIEW RD
Mailing Address - Street 2:#314
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4117
Mailing Address - Country:US
Mailing Address - Phone:714-864-6489
Mailing Address - Fax:
Practice Address - Street 1:2955 FAIRVIEW RD
Practice Address - Street 2:#314
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4117
Practice Address - Country:US
Practice Address - Phone:714-444-4868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN175235164X00000X
HILPN15758164X00000X
AZLP021107164X00000X
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2859974Medicaid
CA7463938Medicaid