Healthcare Provider Details

I. General information

NPI: 1679063457
Provider Name (Legal Business Name): PAUL WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9888 GENESEE AVE
LA JOLLA CA
92037-1205
US

IV. Provider business mailing address

1380 E 5985 S
SALT LAKE CITY UT
84121-1808
US

V. Phone/Fax

Practice location:
  • Phone: 412-385-8626
  • Fax:
Mailing address:
  • Phone: 801-362-2328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: