Provider Demographics
NPI:1760153381
Name:OPHELIA MEDICAL GROUP CA, P.C.
Entity Type:Organization
Organization Name:OPHELIA MEDICAL GROUP CA, P.C.
Other - Org Name:OPHELIA MEDICAL GROUP CA, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:347-857-8015
Mailing Address - Street 1:228 PARK AVE S STE 15314
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1502
Mailing Address - Country:US
Mailing Address - Phone:215-585-2144
Mailing Address - Fax:833-228-5591
Practice Address - Street 1:6920 MIRAMAR ROAD
Practice Address - Street 2:SUITE 329
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2642
Practice Address - Country:US
Practice Address - Phone:215-585-2144
Practice Address - Fax:267-780-7032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty