=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891983185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD A WILLIAMS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2007
-----------------------------------------------------
Last Update Date | 09/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1334 W COVINA BLVD STE 102
-----------------------------------------------------
City | SAN DIMAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91773-3211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-599-8677
-----------------------------------------------------
Fax | 909-592-0999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1334 W COVINA BLVD STE 102
-----------------------------------------------------
City | SAN DIMAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91773-3211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-599-8677
-----------------------------------------------------
Fax | 909-592-0999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/ OWNER
-----------------------------------------------------
Name | DR. RICHARD ANTHONY WILLIAMS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 909-599-8677
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | A040188
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------