MEDICARE: ANGELO WININGS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		CA
2	1041C0700X	Clinical Social Worker	122044	CA

General Provider Information

NPI Number	:	1588385983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELO WININGS

Provider Business Mailing Address
First Line	:	2307 W 6TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3119
Country	:	US
Telephone Number	:	972-834-1473
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 MAIDU AVE
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-8600
Country	:	US
Telephone Number	:	530-265-1291
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2022
Last Update Date	:	09/12/2024

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Directions to “ ANGELO WININGS ” Practice Location

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