Provider Demographics
NPI:1134219686
Name:WILLIAMS-OLANGO, JACQUELINE AVA (MD)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:AVA
Last Name:WILLIAMS-OLANGO
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 1:100 OLD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-8823
Mailing Address - Country:US
Mailing Address - Phone:661-663-4800
Mailing Address - Fax:661-663-4871
Practice Address - Street 1:100 OLD RIVER RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-8823
Practice Address - Country:US
Practice Address - Phone:661-663-4800
Practice Address - Fax:661-663-4871
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA840690207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A840690Medicaid
CAI14755Medicare UPIN
CA00A840690Medicaid