Provider Demographics
NPI:1902849367
Name:WILLIAMS, MONIQUE B (MD)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:B
Last Name:WILLIAMS
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 1:159 E LIVE OAK AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-5249
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:159 E LIVE OAK AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-5249
Practice Address - Country:US
Practice Address - Phone:626-574-3038
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54185207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA54185AMedicare ID - Type Unspecified