Healthcare Provider Details

I. General information

NPI: 1366032443
Provider Name (Legal Business Name): COREY S WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1494 HAMILTON AVE
SAN JOSE CA
95125-4535
US

IV. Provider business mailing address

1893 DIAMENTE CT
SAN JOSE CA
95116-1558
US

V. Phone/Fax

Practice location:
  • Phone: 866-227-1211
  • Fax:
Mailing address:
  • Phone: 650-722-2296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: