Provider Demographics
NPI:1154089209
Name:WILLIAMS, CANDACE (MPH, CHES)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MPH, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10833 LE CONTE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90096-0001
Mailing Address - Country:US
Mailing Address - Phone:424-320-1021
Mailing Address - Fax:
Practice Address - Street 1:10833 LE CONTE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3456
Practice Address - Country:US
Practice Address - Phone:424-320-1021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1133298
Provider Identifiers
StateIdentifier IDID TypeIssuer
1133298OtherNATIONAL COMMISSION FOR HEALTH EDUCATION CREDENTIALING