Healthcare Provider Details

I. General information

NPI: 1407092653
Provider Name (Legal Business Name): PATRICIA WININGER LORENZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 N KAWEAH AVE
EXETER CA
93221-1200
US

IV. Provider business mailing address

516 N KAWEAH AVE
EXETER CA
93221-1200
US

V. Phone/Fax

Practice location:
  • Phone: 559-732-8086
  • Fax: 559-622-0470
Mailing address:
  • Phone: 559-732-8086
  • Fax: 559-622-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number30423
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: