Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | G9922 | CA |
NPI | 1649360918 |
---|---|
Provider Name | Martin A Winston |
First Address | Orangevale, CA 95662-1202 |
Second Address | Carmichael, CA 95608-0306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2006 |
Last Update Date | 09/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A59057 | (02) |