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General NPI Number Information
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NPI Number | 1073068029
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Entity Type | Organization
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Legal Business Name | CENTER FOR LIFESTYLE HEALTH A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/19/2016
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 2079 COMPTON AVE BLDG 3A SUITE 102
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City | CORONA
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State | CA
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Zip | 92881-7284
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Country | US
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Telephone | 951-496-4281
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Fax | 951-496-4222
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Provider Business Mailing Address
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Address Line | 2079 COMPTON AVE BLDG 3A SUITE 102
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City | CORONA
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State | CA
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Zip | 92881-7284
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Country | US
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Telephone | 951-496-4281
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PROVIDER
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Name | DAVE A WILLIAMS
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Credential | MD
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Telephone | 951-496-4281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | A65963
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License Number State | CA
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