Healthcare Provider Details

I. General information

NPI: 1972261063
Provider Name (Legal Business Name): VIP PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 MERCEDES AVE
PASADENA CA
91107-2828
US

IV. Provider business mailing address

281 E COLORADO BLVD UNIT 2499
PASADENA CA
91102-7075
US

V. Phone/Fax

Practice location:
  • Phone: 703-963-2548
  • Fax:
Mailing address:
  • Phone: 703-963-2548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANASTASIA WILLIAMS
Title or Position: OWNER
Credential: MD
Phone: 703-963-2548