Healthcare Provider Details

I. General information

NPI: 1366993271
Provider Name (Legal Business Name): MR. JARVIS WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81557 DR CARREON BLVD SUITE C-9
INDIO CA
92201-5517
US

IV. Provider business mailing address

81557 DR CARREON BLVD SUITE C-9
INDIO CA
92201-5517
US

V. Phone/Fax

Practice location:
  • Phone: 760-391-6999
  • Fax: 760-391-6998
Mailing address:
  • Phone: 760-391-6999
  • Fax: 760-391-6998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: