Provider Demographics
NPI:1558762484
Name:MEDICAL RESOURCE INC
Entity Type:Organization
Organization Name:MEDICAL RESOURCE INC
Other - Org Name:MOBILE MEDICAL RESOURCE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WINIFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-434-0434
Mailing Address - Street 1:5150 CANDLEWOOD ST
Mailing Address - Street 2:SUITE 9E
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1925
Mailing Address - Country:US
Mailing Address - Phone:562-920-9200
Mailing Address - Fax:
Practice Address - Street 1:5150 CANDLEWOOD ST
Practice Address - Street 2:SUITE 9E
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1925
Practice Address - Country:US
Practice Address - Phone:562-920-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70389207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty