Healthcare Provider Details

I. General information

NPI: 1447734249
Provider Name (Legal Business Name): MOBILE VASCULAR RESOURCE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
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 # 301A
LAKEWOOD CA
90805-4549
US

V. Phone/Fax

Practice location:
  • Phone: 562-470-6884
  • Fax: 888-646-5861
Mailing address:
  • Phone: 562-470-6884
  • Fax: 562-616-6619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. WINIFRED WILLIAMS
Title or Position: OWNER
Credential: MD
Phone: 323-434-0434