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General NPI Number Information
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NPI Number | 1033830161
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Entity Type | Organization
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Legal Business Name | WINLOCK PEDIATRICS LLC
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Dates
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Enumeration Date | 09/07/2022
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 19540 FRONT ST NE
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City | POULSBO
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State | WA
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Zip | 98370-7316
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Country | US
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Telephone | 564-218-6135
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Fax |
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Provider Business Mailing Address
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Address Line | 2341 NE WINLOCK WAY
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City | POULSBO
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State | WA
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Zip | 98370-9258
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Country | US
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Telephone | 470-733-0321
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. VIOLETA M GOMEZ
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Credential | MD
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Telephone | 470-733-0321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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