Provider Demographics
NPI:1508804881
Name:WILLIAMS, JOANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 662154
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-2154
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:15107 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4542
Practice Address - Country:US
Practice Address - Phone:818-902-2990
Practice Address - Fax:818-904-3793
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51753207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G517530Medicaid
CA050126CA52073OtherVALLEY PRES TRAILBLAZER
CA00G517530OtherCALOPTIMA
CA00G517530OtherBLUE SHIELD
CAG51753OtherBLUE CROSS
CAWG51753TMedicare PIN
CAA52073Medicare UPIN
CA00G517530Medicaid
CA050126CA52073OtherVALLEY PRES TRAILBLAZER