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General NPI Number Information
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NPI Number | 1194243857
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Entity Type | Organization
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Legal Business Name | LAURA WLLIAMS
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Dates
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Enumeration Date | 09/01/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 433 N 4TH ST SUITE 209
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City | MONTEBELLO
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State | CA
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Zip | 90640
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Country | US
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Telephone | 323-887-3756
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Fax |
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Provider Business Mailing Address
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Address Line | 433 N 4TH ST STE 209
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City | MONTEBELLO
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State | CA
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Zip | 90640-4309
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Country | US
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Telephone | 323-887-3756
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAURA WILLIAMS
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Credential | M.D.
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Telephone | 323-887-3756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 76077
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License Number State | CA
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