Healthcare Provider Details

I. General information

NPI: 1669094355
Provider Name (Legal Business Name): GENA NICOLE WILLIAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 W SUNSET BLVD
LOS ANGELES CA
90027-6070
US

IV. Provider business mailing address

4700 W SUNSET BLVD
LOS ANGELES CA
90027-6070
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-2600
  • Fax:
Mailing address:
  • Phone: 323-783-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number84355
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA201523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: