Provider Demographics
NPI:1720006398
Name:WILLIAMS MD, ALISA LYNN (MD)
Entity Type:Individual
Prefix:MS
First Name:ALISA
Middle Name:LYNN
Last Name:WILLIAMS MD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 RESERVOIR DR STE 307
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5134
Mailing Address - Country:US
Mailing Address - Phone:619-299-3111
Mailing Address - Fax:619-299-3126
Practice Address - Street 1:5555 RESERVOIR DR STE 307
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5134
Practice Address - Country:US
Practice Address - Phone:619-299-3111
Practice Address - Fax:619-299-3126
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGG60944174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE36277Medicare UPIN