Individual
MARY BLACK-WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5050 SAN BERNARDINO ST, MONTCLAIR, CA 91763-2326
(909) 626-2463
(909) 624-6297
Mailing address
3050 E AIRPORT WAY, LONG BEACH, CA 90806-2404
(562) 432-6966
(562) 426-4227
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
231324
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN2313240
MEDI-CAL
CA
Enumeration date
10/05/2006
Last updated
07/08/2007
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