Provider Demographics
NPI:1144500968
Name:WILLIAMS, CINDY (PA)
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15785 LAGUNA CANYON RD, SUITE 390
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618
Mailing Address - Country:US
Mailing Address - Phone:949-333-2999
Mailing Address - Fax:949-387-2002
Practice Address - Street 1:15785 LAGUNA CANYON RD,
Practice Address - Street 2:STE 390
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618
Practice Address - Country:US
Practice Address - Phone:949-333-2999
Practice Address - Fax:949-387-2002
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21408363A00000X
CA21408363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant