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General NPI Number Information
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NPI Number | 1083037873
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Entity Type | Individual
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Provider Name | WILLIAM CORNELL
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Gender | Male
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 01/31/2014
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Provider Practice Location Address
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Address Line | 5585 STANFORD ST
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City | VENTURA
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State | CA
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Zip | 93003-4243
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Country | US
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Telephone | 805-300-4803
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Fax | 866-910-5674
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Provider Business Mailing Address
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Address Line | 5585 STANFORD ST
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City | VENTURA
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State | CA
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Zip | 93003-4243
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Country | US
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Telephone | 805-300-4803
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Fax | 866-910-5674
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 865640
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | 865640
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 865640
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 865640
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License Number State | CA
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