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Individual

WILLIAM CORNELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
5585 STANFORD ST, VENTURA, CA 93003-4243
(805) 300-4803
(866) 910-5674
Mailing address
5585 STANFORD ST, VENTURA, CA 93003-4243
(805) 300-4803
(866) 910-5674

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
865640
CA
171WH0202X
Home Modifications Contractor
865640
CA
332B00000X
Durable Medical Equipment & Medical Supplies
865640
CA
332BC3200X
Customized Equipment (DME)
Primary
865640
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
865640
CALIFORNIA STATE LICENSE BOARD
CA
Enumeration date
01/29/2014
Last updated
01/31/2014
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