Provider Demographics
NPI:1124341474
Name:WILLIAMS, AGATHA ROSE
Entity type:Individual
Prefix:
First Name:AGATHA
Middle Name:ROSE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:ROSE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1400 PARKMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-3797
Mailing Address - Country:US
Mailing Address - Phone:408-510-3480
Mailing Address - Fax:408-510-3484
Practice Address - Street 1:1400 PARKMOOR AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-3797
Practice Address - Country:US
Practice Address - Phone:408-510-3480
Practice Address - Fax:408-510-3484
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator