Healthcare Provider Details

I. General information

NPI: 1720286768
Provider Name (Legal Business Name): WINNIFRED V GRIFFIN PHYSCIAN ASST.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 DELBON AVE
TURLOCK CA
95382-2021
US

IV. Provider business mailing address

1100 DELBON AVE
TURLOCK CA
95382-2021
US

V. Phone/Fax

Practice location:
  • Phone: 209-667-0905
  • Fax: 209-667-0974
Mailing address:
  • Phone: 209-667-0905
  • Fax: 209-667-0974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number11601
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: