Healthcare Provider Details

I. General information

NPI: 1386117273
Provider Name (Legal Business Name): KIRK WINTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3919 W HAZARD AVE
SANTA ANA CA
92703-2625
US

IV. Provider business mailing address

5405 GARDEN GROVE BLVD STE 100
WESTMINSTER CA
92683-1887
US

V. Phone/Fax

Practice location:
  • Phone: 800-970-3973
  • Fax:
Mailing address:
  • Phone: 714-713-5272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number220768
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: