Provider Demographics
NPI:1508667924
Name:PURIFY-WILLIAMS, BOBBIE RAYEDNA
Entity type:Individual
Prefix:
First Name:BOBBIE
Middle Name:RAYEDNA
Last Name:PURIFY-WILLIAMS
Suffix:
Gender:
Credentials:
Other - Prefix:MS
Other - First Name:BOBBIE
Other - Middle Name:RAYEDNA
Other - Last Name:PURIFY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3418 18TH ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-2746
Mailing Address - Country:US
Mailing Address - Phone:707-740-9944
Mailing Address - Fax:
Practice Address - Street 1:3418 18TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-2746
Practice Address - Country:US
Practice Address - Phone:707-740-9944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
AZ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program