Healthcare Provider Details

I. General information

NPI: 1073681342
Provider Name (Legal Business Name): JUERGEN G WINKLER MD, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 S EL CAMINO REAL STE 104
OCEANSIDE CA
92054-6377
US

IV. Provider business mailing address

2204 S EL CAMINO REAL STE 104
OCEANSIDE CA
92054-6377
US

V. Phone/Fax

Practice location:
  • Phone: 760-439-9955
  • Fax: 760-439-6755
Mailing address:
  • Phone: 760-439-9955
  • Fax: 760-439-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberG67075
License Number StateCA

VIII. Authorized Official

Name: DR. JUERGEN GERNOT WINKLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-439-9955