Healthcare Provider Details

I. General information

NPI: 1225364235
Provider Name (Legal Business Name): AMY WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 W MILL ST
SAN BERNARDINO CA
92408-1402
US

IV. Provider business mailing address

2191 JOHNSON AVE
SAN LUIS OBISPO CA
93401-4534
US

V. Phone/Fax

Practice location:
  • Phone: 909-888-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number719659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: