Healthcare Provider Details

I. General information

NPI: 1790777852
Provider Name (Legal Business Name): JAN A WINETZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 SAMARITAN DR STE 405
SAN JOSE CA
95124-4006
US

IV. Provider business mailing address

2505 SAMARITAN DR STE 405
SAN JOSE CA
95124-4006
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-8133
  • Fax: 408-356-6923
Mailing address:
  • Phone: 408-356-8133
  • Fax: 408-356-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberG412450
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: