Healthcare Provider Details

I. General information

NPI: 1730364688
Provider Name (Legal Business Name): MASCHA LOREA WILLIAMS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1A CLIFTON HILL
KINGSHILL VI
00850
US

IV. Provider business mailing address

RR 2 BOX 11230
KINGSHILL VI
00850-9618
US

V. Phone/Fax

Practice location:
  • Phone: 340-772-2225
  • Fax: 340-772-5900
Mailing address:
  • Phone: 340-772-2225
  • Fax: 340-772-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number30409
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number56
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: