Provider Demographics
NPI:1578148672
Name:WILLIAMS, CYNTHIA D (LVN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:HOUSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:1031 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-3413
Mailing Address - Country:US
Mailing Address - Phone:310-409-3635
Mailing Address - Fax:909-614-8058
Practice Address - Street 1:1568 MCLEOD PL
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-1348
Practice Address - Country:US
Practice Address - Phone:626-814-9085
Practice Address - Fax:626-814-2276
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA711002164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse