Healthcare Provider Details

I. General information

NPI: 1962962944
Provider Name (Legal Business Name): HAYLEY DEROME WINNINGHOFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 BLOSSOM HILL RD
SAN JOSE CA
95123-1105
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 408-445-4010
  • Fax:
Mailing address:
  • Phone: 650-405-9218
  • Fax: 707-651-5624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA176060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: