MEDICARE: MOBILE VASCULAR RESOURCE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1447734249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE VASCULAR RESOURCE INC.

Provider Business Mailing Address
First Line	:	3300 E SOUTH ST # 301A
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90805-4549
Country	:	US
Telephone Number	:	562-470-6884
Fax Number	:	562-616-6619

Provider Business Practice Location Address
First Line	:	7345 TOPANGA CANYON BLVD STE 130
Second Line	:
City	:	CANOGA PARK
State	:	CA
Zip	:	91303-1244
Country	:	US
Telephone Number	:	562-470-6884
Fax Number	:	888-646-5861

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WINIFRED WILLIAMS
Credential	:	MD
Telephone Number	:	323-434-0434

Provider Enumeration Date	:	09/18/2018
Last Update Date	:	06/23/2021

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Directions to “MOBILE VASCULAR RESOURCE INC. ” Practice Location

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