Provider Demographics
NPI:1326827940
Name:WILLIAMS, MARITZA GABRIELLA
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:GABRIELLA
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 1:6336 ORANGE AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5876
Mailing Address - Country:US
Mailing Address - Phone:949-351-9597
Mailing Address - Fax:
Practice Address - Street 1:2900 BRISTOL ST STE J105
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7919
Practice Address - Country:US
Practice Address - Phone:949-351-9597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6952225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist