Provider Demographics
NPI:1962068858
Name:HOUSEMAN, CODY J (CRNA)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:J
Last Name:HOUSEMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:450 N ROXBURY DR STE 240
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4240
Practice Address - Country:US
Practice Address - Phone:310-651-2040
Practice Address - Fax:310-651-2042
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANA95001143367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered