Provider Demographics
NPI:1578796868
Name:WILLIAMS, ANGELA R (DIET TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DIET TECHNICIAN
Other - Prefix:
Other - First Name:HEALTH &
Other - Middle Name:FITNESS
Other - Last Name:4 U
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CONSULTANT
Mailing Address - Street 1:298 W FUEGO ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-1117
Mailing Address - Country:US
Mailing Address - Phone:310-537-1025
Mailing Address - Fax:
Practice Address - Street 1:298 W FUEGO ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-1117
Practice Address - Country:US
Practice Address - Phone:310-537-1025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABU20815760133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA133NN1002XOtherNUTRITION & FITNESS CONSULTANT
CA133NN1002XOtherNUTRITIONIST CONSULTANT