Provider Demographics
NPI:1194111716
Name:WILLIAMS, TAMAL (MS, RD, CDE)
Entity type:Individual
Prefix:
First Name:TAMAL
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22848 SHELL DR
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-4744
Mailing Address - Country:US
Mailing Address - Phone:310-722-1087
Mailing Address - Fax:
Practice Address - Street 1:22848 SHELL DR
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-4744
Practice Address - Country:US
Practice Address - Phone:310-722-1087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1058879133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered