MEDICARE: DR. LISA WINCHESTER MD

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	2080N0001X	Neonatal-Perinatal Medicine Physician	A92650	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00A926500 L81	OTHER	CA	CAL OPTIMA

General Provider Information

NPI Number	:	1609963024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA WINCHESTER MD

Provider Business Mailing Address
First Line	:	PO BOX 859
Second Line	:
City	:	HUMACAO
State	:	PR
Zip	:	00792-0859
Country	:	US
Telephone Number	:	787-852-0768
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 AVE FONT MARTELO
Second Line	:
City	:	HUMACAO
State	:	PR
Zip	:	00791-3249
Country	:	US
Telephone Number	:	787-852-0768
Fax Number	:

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	08/10/2007

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