Healthcare Provider Details

I. General information

NPI: 1427198621
Provider Name (Legal Business Name): KIA LYNN WINLOCK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 UCLA MEDICAL PLZ STE 430
LOS ANGELES CA
90095-8344
US

IV. Provider business mailing address

200 UCLA MEDICAL PLZ STE 430
LOS ANGELES CA
90095-8344
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-5172
  • Fax: 310-794-7436
Mailing address:
  • Phone: 310-825-5172
  • Fax: 310-794-7436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: