Healthcare Provider Details

I. General information

NPI: 1225899875
Provider Name (Legal Business Name): DEANGELO WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3472 CATTLE DR
SACRAMENTO CA
95834-1416
US

IV. Provider business mailing address

3472 CATTLE DR
SACRAMENTO CA
95834-1416
US

V. Phone/Fax

Practice location:
  • Phone: 916-256-8140
  • Fax:
Mailing address:
  • Phone: 916-256-8140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT02384989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: