1073711867 NPI number — MRS. PATRICIA ANN WILLIAMS

Table of content: MRS. PATRICIA ANN WILLIAMS (NPI 1073711867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073711867 NPI number — MRS. PATRICIA ANN WILLIAMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
PATRICIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073711867
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2710 W 76TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INGLEWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90305-1003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-778-0566
Provider Business Mailing Address Fax Number:
323-778-0547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4920 AVALON BLVD
Provider Second Line Business Practice Location Address:
BAART
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90011-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-235-5035
Provider Business Practice Location Address Fax Number:
323-235-2023
Provider Enumeration Date:
07/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)