Healthcare Provider Details

I. General information

NPI: 1003334152
Provider Name (Legal Business Name): RANDAL REGINALD WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17264 EUCLID ST APT H
FOUNTAIN VALLEY CA
92708-4947
US

IV. Provider business mailing address

17264 EUCLID ST APT H
FOUNTAIN VALLEY CA
92708-4947
US

V. Phone/Fax

Practice location:
  • Phone: 949-300-6415
  • Fax:
Mailing address:
  • Phone: 949-300-6415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number131190
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: