Healthcare Provider Details

I. General information

NPI: 1972808228
Provider Name (Legal Business Name): FITZROY D WINTERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 N LAMB BLVD UNIT F
LAS VEGAS NV
89110-0510
US

IV. Provider business mailing address

213 N LAMB BLVD UNIT F
LAS VEGAS NV
89110-0510
US

V. Phone/Fax

Practice location:
  • Phone: 510-703-3311
  • Fax:
Mailing address:
  • Phone: 510-703-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: