Provider Demographics
NPI:1841485752
Name:WINIFRED WILLIAMS MD INC, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:WINIFRED WILLIAMS MD INC, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:WINIFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-329-4300
Mailing Address - Street 1:1141 W REDONDO BEACH BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3583
Mailing Address - Country:US
Mailing Address - Phone:310-329-4300
Mailing Address - Fax:310-329-4309
Practice Address - Street 1:1141 W REDONDO BEACH BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3583
Practice Address - Country:US
Practice Address - Phone:310-329-4300
Practice Address - Fax:310-329-4309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70389208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A703890Medicaid