Healthcare Provider Details

I. General information

NPI: 1316473655
Provider Name (Legal Business Name): WINONA GABRIELLE BAETIONG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WINONA GABRIELLE GARCIA ACSW

II. Dates (important events)

Enumeration Date: 05/05/2017
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30755 AULD RD STE B
MURRIETA CA
92563-2581
US

IV. Provider business mailing address

37931 VERANDA WAY
MURRIETA CA
92563-4777
US

V. Phone/Fax

Practice location:
  • Phone: 951-696-3112
  • Fax:
Mailing address:
  • Phone: 619-696-3112
  • Fax: 619-294-9405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number123285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: