MEDICARE: DESIREE CLAIRE WILLIAMS-TRINIDAD

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	1041C0700X	Clinical Social Worker	113424	CA

General Provider Information

NPI Number	:	1770289548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIREE CLAIRE WILLIAMS-TRINIDAD

Provider Business Mailing Address
First Line	:	269 S BEVERLY DR
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3851
Country	:	US
Telephone Number	:	310-741-0006
Fax Number	:

Provider Business Practice Location Address
First Line	:	1638 VIRGINIA RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-5934
Country	:	US
Telephone Number	:	310-741-0006
Fax Number	:

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

Provider Enumeration Date	:	02/03/2023
Last Update Date	:	02/03/2023

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