MEDICARE: OFELIA LOPEZ WILLIAMS CERTIFIED NURSE PRACTITIONER INC

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
1	363LF0000X	Family Nurse Practitioner	NP950	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154474989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OFELIA LOPEZ WILLIAMS CERTIFIED NURSE PRACTITIONER INC

Provider Business Mailing Address
First Line	:	82013 DOCTOR CARREON BLVD
Second Line	:	SUITE M
City	:	INDIO
State	:	CA
Zip	:	92201-5832
Country	:	US
Telephone Number	:	760-342-4242
Fax Number	:

Provider Business Practice Location Address
First Line	:	82013 DOCTOR CARREON BLVD
Second Line	:	SUITE M
City	:	INDIO
State	:	CA
Zip	:	92201-5832
Country	:	US
Telephone Number	:	760-342-4242
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. OFELIA LOPEZ WILLIAMS
Credential	:	FNP
Telephone Number	:	760-342-4242

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	09/05/2007

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