Healthcare Provider Details

I. General information

NPI: 1619986460
Provider Name (Legal Business Name): JUDITH ANN WINHOVEN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 PALM AVE
IMPERIAL BEACH CA
91932-1503
US

IV. Provider business mailing address

949 PALM AVE
IMPERIAL BEACH CA
91932-1503
US

V. Phone/Fax

Practice location:
  • Phone: 619-429-3733
  • Fax: 619-429-3823
Mailing address:
  • Phone: 619-429-3733
  • Fax: 619-429-3823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1155
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5554
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: