Healthcare Provider Details

I. General information

NPI: 1417568122
Provider Name (Legal Business Name): ANNALISE WINTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 PARAMOUNT BLVD STE 402
DOWNEY CA
90241-3334
US

IV. Provider business mailing address

13200 CROSSROADS PKWY N STE 300
CITY OF INDUSTRY CA
91746-3459
US

V. Phone/Fax

Practice location:
  • Phone: 562-821-1491
  • Fax: 562-362-3137
Mailing address:
  • Phone: 562-821-1491
  • Fax: 562-362-3137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number128245
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: