Provider Demographics
NPI:1962966531
Name:WILLIAMS, ELIZABETH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:DOUDERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28066 KLAMATH CT
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7018
Mailing Address - Country:US
Mailing Address - Phone:951-837-0301
Mailing Address - Fax:
Practice Address - Street 1:28066 KLAMATH CT
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-7018
Practice Address - Country:US
Practice Address - Phone:951-837-0301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2024-12-15
Deactivation Date:2024-01-17
Deactivation Code:
Reactivation Date:2024-10-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator