Provider Demographics
NPI:1861482531
Name:WILLIAMS, LAURA ANN (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25102 JEFFERSON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-1707
Mailing Address - Country:US
Mailing Address - Phone:951-696-4009
Mailing Address - Fax:951-696-8448
Practice Address - Street 1:25102 JEFFERSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-1707
Practice Address - Country:US
Practice Address - Phone:951-696-4009
Practice Address - Fax:951-696-8448
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457442121OtherNPI ORGANIZATION
CA00G76077Medicaid
CA1861482531OtherNPI INDIVIDUAL
CA05D1051900OtherCLIA #
CAG76077OtherMEDICAL LICENSE
CA10977784OtherCAQH #
CA10977784OtherCAQH #
CABW6985949OtherDEA #