Healthcare Provider Details

I. General information

NPI: 1932178779
Provider Name (Legal Business Name): WILLIAM WINSTON BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 MARSH ST
SAN LUIS OBISPO CA
93401-3326
US

IV. Provider business mailing address

1240 MARSH ST
SAN LUIS OBISPO CA
93401-3326
US

V. Phone/Fax

Practice location:
  • Phone: 805-547-0955
  • Fax: 805-547-0965
Mailing address:
  • Phone: 805-547-0955
  • Fax: 805-547-0965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA3571
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: