Provider Demographics
NPI:1467841205
Name:WILLIAMS, IRVING JR
Entity Type:Individual
Prefix:
First Name:IRVING
Middle Name:
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 S RAINBOW BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-9047
Mailing Address - Country:US
Mailing Address - Phone:702-380-8118
Mailing Address - Fax:702-380-2929
Practice Address - Street 1:1321 S RAINBOW BLVD STE 240
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-9047
Practice Address - Country:US
Practice Address - Phone:702-380-8118
Practice Address - Fax:702-380-2929
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner