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NPI Code Detail

MEDICARE: MS. TANISHA G WILLIAMS PA

MEDICARE: MS. TANISHA G WILLIAMS PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA15707CA

General Provider Information

NPI Number : 1013951417
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TANISHA G WILLIAMS PA
Provider Business Mailing Address
First Line : 2100 POWELL ST
Second Line : SUITE 900
City : EMERYVILLE
State : CA
Zip : 94608-1826
Country : US
Telephone Number : 510-350-2673
Fax Number : 510-879-9059
Provider Business Practice Location Address
First Line : 1805 MEDICAL CENTER DR
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92411-1217
Country : US
Telephone Number : 909-887-6333
Fax Number : 909-887-1985
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2006
Last Update Date : 09/15/2011

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