Provider Demographics
NPI:1902905664
Name:BILLIPS, MAVIS WILLIAMS (MD)
Entity Type:Individual
Prefix:DR
First Name:MAVIS
Middle Name:WILLIAMS
Last Name:BILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MAVIS
Other - Middle Name:THEODORA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4712 ADMIRALTY WAY
Mailing Address - Street 2:SUITE 665
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6905
Mailing Address - Country:US
Mailing Address - Phone:310-678-2686
Mailing Address - Fax:310-651-8254
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:SUITE 1135 E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-651-8240
Practice Address - Fax:310-651-8254
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA051005174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist