Demetrius Williams
Individual provider Active NPI Phlebotomy Technician · San Luis Rey, CA
NPI 1013784776 · NPPES record last updated Dec 4, 2023
Key facts
- NPI
- 1013784776
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Phlebotomy Technician 246RP1900X
- License
- 00074153 (CA)
- Practice address
- 4109 Via Mar
San Luis Rey, CA 92057 - Phone
- (619) 949-8896
- NPI assigned
- Dec 4, 2023
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00074153 | CA | MD | Phlebotomy Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Phlebotomy Technician | 246RP1900X | 00074153 | CA | Yes |
Addresses
Primary practice location
4109 Via Mar
San Luis Rey, CA 92057
Mailing address
PO Box 68
San Luis Rey, CA 92068-0068
Phone (858) 717-0328
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.