MEDICARE: MS. ALISA LYNN WILLIAMS MD M.D.

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	GG60944	CA

General Provider Information

NPI Number	:	1720006398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALISA LYNN WILLIAMS MD M.D.

Provider Business Mailing Address
First Line	:	5555 RESERVOIR DR STE 307
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5134
Country	:	US
Telephone Number	:	619-299-3111
Fax Number	:	619-299-3126

Provider Business Practice Location Address
First Line	:	5555 RESERVOIR DR STE 307
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5134
Country	:	US
Telephone Number	:	619-299-3111
Fax Number	:	619-299-3126

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	01/02/2020

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