Provider Demographics
NPI:1154018802
Name:WILLIAMS, CHRISTOPHER MALCOLM
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MALCOLM
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 1:5435 BRADNA DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-2109
Mailing Address - Country:US
Mailing Address - Phone:305-209-9150
Mailing Address - Fax:
Practice Address - Street 1:5435 BRADNA DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-2109
Practice Address - Country:US
Practice Address - Phone:305-209-9150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide