Provider Demographics
NPI:1982788253
Name:WILLIAMS, WINIFRED (MD)
Entity type:Individual
Prefix:
First Name:WINIFRED
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 1:3300 E SOUTH ST STE 301A
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90805-4549
Mailing Address - Country:US
Mailing Address - Phone:323-434-0434
Mailing Address - Fax:562-616-6619
Practice Address - Street 1:7345 TOPANGA CANYON BLVD STE 130
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1244
Practice Address - Country:US
Practice Address - Phone:323-434-0434
Practice Address - Fax:562-616-6619
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70389208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A703890Medicaid
CA00A703890Medicaid
CAW19554Medicare ID - Type Unspecified