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General NPI Number Information
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NPI Number | 1386292878
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Entity Type | Individual
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Provider Name | AVERY M WILLIAMS PHLEBOTOMY, EMT
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Gender | Male
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 25096 JEFFERSON AVE STE B-206
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City | MURRIETA
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State | CA
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Zip | 92562-1705
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Country | US
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Telephone | 925-321-6353
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Fax |
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Provider Business Mailing Address
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Address Line | 25096 JEFFERSON AVE STE B-206
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City | MURRIETA
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State | CA
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Zip | 92562-1705
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Country | US
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Telephone | 925-321-6353
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Fax |
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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 | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number | E113393
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | CPT58240
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License Number State | CA
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