=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457442121
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAURA WILLIAMS MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25102 JEFFERSON AVE SUITE A
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92562-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-696-4009
-----------------------------------------------------
Fax | 951-696-8448
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25102 JEFFERSON AVE SUITE A
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92562-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-696-4009
-----------------------------------------------------
Fax | 951-696-8448
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LAURA A WILLIAMS
-----------------------------------------------------
Credential | MD, MPH
-----------------------------------------------------
Telephone | 951-696-4009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | G76077
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------