Healthcare Provider Details

I. General information

NPI: 1942098850
Provider Name (Legal Business Name): K. LAUREN DE WINTER MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2888 LONG BEACH BLVD STE 325
LONG BEACH CA
90806-7503
US

IV. Provider business mailing address

2888 LONG BEACH BLVD STE 325
LONG BEACH CA
90806-7503
US

V. Phone/Fax

Practice location:
  • Phone: 562-426-4904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KARA LAUREN DE WINTER
Title or Position: PRESIDENT
Credential: MD
Phone: 562-426-4904