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General NPI Number Information
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NPI Number | 1750539391
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Entity Type | Individual
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Provider Name | TARQUIN SIAM WILLIAMS PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/08/2008
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 69175 RAMON RD BLDG A
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City | CATHEDRAL CITY
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State | CA
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Zip | 92234-3344
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Country | US
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Telephone | 760-321-6776
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Fax |
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Provider Business Mailing Address
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Address Line | 231 E ALESSANDRO BLVD # A140
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City | RIVERSIDE
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State | CA
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Zip | 92508-5084
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Country | US
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Telephone | 951-941-1922
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA19872
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA19872
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License Number State | CA
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