Organization Active NPI

Mobile Vascular Resource Inc.

  • Internal Medicine Physician
  • Canoga Park, CA
National Provider Identifier
1447734249
Registry record updated Jun 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MOBILE VASCULAR RESOURCE INC.
Practice address
7345 Topanga Canyon Blvd Ste 130
Canoga Park, CA 91303-1244
Phone
(562) 470-6884
Fax
(888) 646-5861
NPI assigned
Sep 18, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Winifred Williams, MDNPI 1982788253
Title
Owner
Phone
(323) 434-0434

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X

Addresses

Primary practice location

7345 Topanga Canyon Blvd Ste 130
Canoga Park, CA 91303-1244

Mailing address

3300 E South St # 301a
Lakewood, CA 90805-4549
Phone (562) 470-6884

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220628000871 CA Part B Supplier - Clinic/Group Practice 3274869979 Receives reassigned benefits from 1 practitioner
Practice locations: Canoga Park, CA

National Provider Directory

National Provider Directory
Tax ID family
Mobile Vascular Resource Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7345 Topanga Canyon Blvd
Ste 130
Canoga Park, CA 91303
Phone (562) 470-6884

3300 E South St
Lakewood, CA 90805
Phone (562) 232-1144

5150 Candlewood St
Ste 15A
Lakewood, CA 90712

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624406400000",
    "number": "1447734249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 E SOUTH ST # 301A",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "908054549",
            "telephone_number": "562-470-6884",
            "fax_number": "562-616-6619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7345 TOPANGA CANYON BLVD STE 130",
            "city": "CANOGA PARK",
            "state": "CA",
            "postal_code": "913031244",
            "telephone_number": "562-470-6884",
            "fax_number": "888-646-5861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE VASCULAR RESOURCE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-18",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "WINIFRED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "323-434-0434",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canoga Park, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.