Healthcare Provider Details

I. General information

NPI: 1982995676
Provider Name (Legal Business Name): LISA MARIE WILLIAMS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 347-861-5500
  • Fax:
Mailing address:
  • Phone: 347-861-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA126923
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: