Provider Demographics
NPI:1326451857
Name:WILLIAMS, ANNJONETTE
Entity Type:Individual
Prefix:
First Name:ANNJONETTE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W MINTHORN ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-2800
Mailing Address - Country:US
Mailing Address - Phone:323-684-7212
Mailing Address - Fax:
Practice Address - Street 1:311 W MINTHORN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-2800
Practice Address - Country:US
Practice Address - Phone:323-684-7212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies