Healthcare Provider Details

I. General information

NPI: 1346190006
Provider Name (Legal Business Name): DESIRAYE ELAINE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25640 SIERRA BELLO CT
MORENO VALLEY CA
92551-2141
US

IV. Provider business mailing address

25640 SIERRA BELLO CT
MORENO VALLEY CA
92551-2141
US

V. Phone/Fax

Practice location:
  • Phone: 909-243-5413
  • Fax:
Mailing address:
  • Phone: 909-243-5413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: