Healthcare Provider Details

I. General information

NPI: 1902201643
Provider Name (Legal Business Name): BRANDON WINKLES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13951 MONO WAY STE A
SONORA CA
95370-2830
US

IV. Provider business mailing address

PO BOX 1139
BAKERSFIELD CA
93302-1139
US

V. Phone/Fax

Practice location:
  • Phone: 209-532-3370
  • Fax:
Mailing address:
  • Phone: 661-371-2796
  • Fax: 661-438-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number52035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: