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General NPI Number Information
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NPI Number | 1871252536
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Entity Type | Organization
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Legal Business Name | INFINITI MEDICAL SERVICES, PC
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Dates
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Enumeration Date | 12/09/2021
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 3111 WINONA AVE
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City | BURBANK
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State | CA
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Zip | 91504-2538
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Country | US
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Telephone | 310-909-8979
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Fax | 305-440-0906
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Provider Business Mailing Address
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Address Line | 3111 WINONA AVE
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City | BURBANK
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State | CA
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Zip | 91504-2538
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Country | US
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Telephone | 310-909-8979
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Fax | 305-440-0906
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Authorized Official
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Title or Position | OWNER
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Name | AVERY M WILLIAMS
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Credential |
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Telephone | 925-321-6353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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