MEDICARE: DR. JEFFREY CARL WINTER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY6795	CA

General Provider Information

NPI Number	:	1396904850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY CARL WINTER PH.D.

Provider Business Mailing Address
First Line	:	823 GATEWAY CENTER WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-4541
Country	:	US
Telephone Number	:	619-906-4623
Fax Number	:	619-906-4564

Provider Business Practice Location Address
First Line	:	6350 RAYDEL CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-4722
Country	:	US
Telephone Number	:	619-865-4475
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	12/09/2016

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