Provider Demographics
NPI:1386292878
Name:WILLIAMS, AVERY M (PHLEBOTOMY, EMT)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHLEBOTOMY, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25096 JEFFERSON AVE STE B-206
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-1705
Mailing Address - Country:US
Mailing Address - Phone:925-321-6353
Mailing Address - Fax:
Practice Address - Street 1:25096 JEFFERSON AVE STE B-206
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-1705
Practice Address - Country:US
Practice Address - Phone:925-321-6353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE113393146N00000X
374U00000X
CA376K00000X
CACPT58240246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide