MEDICARE: DR. BRENTON WINSHIP

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
2	208100000X	Physical Medicine & Rehabilitation Physician	A146359	CA

General Provider Information

NPI Number	:	1821428053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENTON WINSHIP

Provider Business Mailing Address
First Line	:	2035 16TH AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95822-1323
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2080 CENTURY PARK E STE 300
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-2006
Country	:	US
Telephone Number	:	424-522-7100
Fax Number	:	424-522-7900

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

Provider Enumeration Date	:	11/25/2013
Last Update Date	:	10/24/2019

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Directions to “ DR. BRENTON WINSHIP ” Practice Location

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