Provider Demographics
NPI:1467419366
Name:MADRID, WILLIAM L (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:MADRID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3650 SOUTH ST
Mailing Address - Street 2:STE. #310
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1502
Mailing Address - Country:US
Mailing Address - Phone:562-531-1980
Mailing Address - Fax:562-531-7952
Practice Address - Street 1:3650 SOUTH ST STE 310
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1519
Practice Address - Country:US
Practice Address - Phone:562-531-1980
Practice Address - Fax:562-531-7952
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA48312207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A483120Medicaid
CA00A483120Medicaid
CAWA48312DMedicare PIN