Healthcare Provider Details

I. General information

NPI: 1760526743
Provider Name (Legal Business Name): CHARLES R WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6709 LA TIJERA BLVD STE 1237
LOS ANGELES CA
90045-2017
US

IV. Provider business mailing address

6709 LA TIJERA BLVD STE 1237
LOS ANGELES CA
90045-2017
US

V. Phone/Fax

Practice location:
  • Phone: 480-262-4415
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG51191
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG51191
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: