Healthcare Provider Details

I. General information

NPI: 1871851014
Provider Name (Legal Business Name): DIANE PATRICIA WINTER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANE PATRICIA HOLSTEIN WINTER R.N.

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 REDONDO AVE FL 3
LONG BEACH CA
90806-2325
US

IV. Provider business mailing address

2600 REDONDO AVE FL 3
LONG BEACH CA
90806-2325
US

V. Phone/Fax

Practice location:
  • Phone: 562-256-2979
  • Fax:
Mailing address:
  • Phone: 562-256-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number3508
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number510124
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number510124
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number163W00000X
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number510124
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: