Healthcare Provider Details

I. General information

NPI: 1639587603
Provider Name (Legal Business Name): WILLIAM SWANSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 12/13/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

4647 ZION AVE STE 1116
SAN DIEGO CA
92120-2507
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-8570
  • Fax: 916-734-7950
Mailing address:
  • Phone: 714-609-5274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA150583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: