=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922491521
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE C WILLIAMS PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2015
-----------------------------------------------------
Last Update Date | 11/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 437 S HIGHWAY 101 STE 217
-----------------------------------------------------
City | SOLANA BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92075-2221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-792-7546
-----------------------------------------------------
Fax | 858-792-7007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 437 S HIGHWAY 101 STE 217
-----------------------------------------------------
City | SOLANA BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92075-2221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-792-7546
-----------------------------------------------------
Fax | 858-792-7007
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 52356
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------