Provider Demographics
NPI:1932128691
Name:WILLIAMS, DIANE ELIZABETH (AU D)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ELIZABETH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7024 AIRWAY AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3069
Mailing Address - Country:US
Mailing Address - Phone:760-228-1381
Mailing Address - Fax:760-228-1481
Practice Address - Street 1:7024 AIRWAY AVE
Practice Address - Street 2:SUITE D
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3069
Practice Address - Country:US
Practice Address - Phone:760-228-1381
Practice Address - Fax:760-228-1481
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1864231H00000X
OK222231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA612095900OtherDEPARTMENT OF LABOR
CAAU0018640Medicaid
CAZZZ62950Z, ZZZ62951ZOtherBLUE SHIELD
CABA529Medicare PIN