Healthcare Provider Details

I. General information

NPI: 1982788253
Provider Name (Legal Business Name): WINIFRED WILLIAMS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 TOPANGA CANYON BLVD STE 130
CANOGA PARK CA
91303-1244
US

IV. Provider business mailing address

3300 E SOUTH ST STE 301A
LAKEWOOD CA
90805-4549
US

V. Phone/Fax

Practice location:
  • Phone: 323-434-0434
  • Fax: 562-616-6619
Mailing address:
  • Phone: 323-434-0434
  • Fax: 562-616-6619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA70389
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA70389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: