Provider Demographics
NPI:1932452224
Name:WILLIAMS, TYRELL EDWARD
Entity Type:Individual
Prefix:
First Name:TYRELL
Middle Name:EDWARD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7244 PASEO PLOMO
Mailing Address - Street 2:# 204
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-2025
Mailing Address - Country:US
Mailing Address - Phone:760-521-4248
Mailing Address - Fax:760-304-0246
Practice Address - Street 1:7244 PASEO PLOMO
Practice Address - Street 2:# 204
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-2025
Practice Address - Country:US
Practice Address - Phone:760-521-4248
Practice Address - Fax:760-304-0246
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker