Provider Demographics
NPI:1114657558
Name:WILLIAMS, LINDA CHRISTINE (R1358180819)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:CHRISTINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:R1358180819
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13219
Mailing Address - Street 2:
Mailing Address - City:COYOTE
Mailing Address - State:CA
Mailing Address - Zip Code:95013-3219
Mailing Address - Country:US
Mailing Address - Phone:408-281-6555
Mailing Address - Fax:
Practice Address - Street 1:9500 MALECH RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95138-9503
Practice Address - Country:US
Practice Address - Phone:408-281-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1358180819171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator