MEDICARE: CYNTHIA M WILLIAMS A PROFESSIONAL MEDICAL CORPORATION

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	174400000X	Specialist	20A5305	CA

General Provider Information

NPI Number	:	1538508262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYNTHIA M WILLIAMS A PROFESSIONAL MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	1247 PENNSYLVANIA AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-4412
Country	:	US
Telephone Number	:	301-502-1726
Fax Number	:	619-425-5869

Provider Business Practice Location Address
First Line	:	1247 PENNSYLVANIA AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-4412
Country	:	US
Telephone Number	:	301-502-1726
Fax Number	:	619-425-5869

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CYNTHIA M WILLIAMS
Credential	:	D.O.
Telephone Number	:	301-502-1726

Provider Enumeration Date	:	06/16/2013
Last Update Date	:	06/16/2013

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