Healthcare Provider Details

I. General information

NPI: 1730165754
Provider Name (Legal Business Name): CAROLYN C WILLIAMS AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PROVIDENCE AVENUE
ORANGE CA
92868-8344
US

IV. Provider business mailing address

2021 W CHANDLER AVE
SANTA ANA CA
92704-6114
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-4990
  • Fax: 714-221-0977
Mailing address:
  • Phone: 714-662-0760
  • Fax: 714-662-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU2192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: