Healthcare Provider Details

I. General information

NPI: 1932843679
Provider Name (Legal Business Name): MARK JOSHUA WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 16TH ST
SANTA MONICA CA
90404-1249
US

IV. Provider business mailing address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-8358
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-9111
  • Fax:
Mailing address:
  • Phone: 951-288-2684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA206829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: