Provider Demographics
NPI:1821231275
Name:WILLIAMS JEFFERSON, DEBBY DENISE
Entity Type:Individual
Prefix:
First Name:DEBBY
Middle Name:DENISE
Last Name:WILLIAMS JEFFERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LANDALE
Other - Middle Name:MEDICAL
Other - Last Name:BILLING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:45656 17TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-5194
Mailing Address - Country:US
Mailing Address - Phone:661-729-1182
Mailing Address - Fax:661-206-5007
Practice Address - Street 1:45656 17TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-5194
Practice Address - Country:US
Practice Address - Phone:661-729-1182
Practice Address - Fax:661-206-5007
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies