Provider Demographics
NPI:1508289190
Name:WILLIAMS, CALLEY (LAC)
Entity Type:Individual
Prefix:
First Name:CALLEY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 ORANGE ST
Mailing Address - Street 2:APT 2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4860
Mailing Address - Country:US
Mailing Address - Phone:424-261-8778
Mailing Address - Fax:
Practice Address - Street 1:183 N MARTEL AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-2756
Practice Address - Country:US
Practice Address - Phone:424-261-8778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-02
Last Update Date:2014-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15638171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist