Healthcare Provider Details

I. General information

NPI: 1841485752
Provider Name (Legal Business Name): WINIFRED WILLIAMS MD INC, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 W REDONDO BEACH BLVD SUITE 302
GARDENA CA
90247-3583
US

IV. Provider business mailing address

1141 W REDONDO BEACH BLVD SUITE 302
GARDENA CA
90247-3583
US

V. Phone/Fax

Practice location:
  • Phone: 310-329-4300
  • Fax: 310-329-4309
Mailing address:
  • Phone: 310-329-4300
  • Fax: 310-329-4309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. WINIFRED WILLIAMS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 310-329-4300