Provider Demographics
NPI:1316473655
Name:BAETIONG, WINONA GABRIELLE (ACSW)
Entity type:Individual
Prefix:MRS
First Name:WINONA
Middle Name:GABRIELLE
Last Name:BAETIONG
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:MS
Other - First Name:WINONA
Other - Middle Name:GABRIELLE
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACSW
Mailing Address - Street 1:37931 VERANDA WAY
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563
Mailing Address - Country:US
Mailing Address - Phone:619-278-2400
Mailing Address - Fax:619-294-9405
Practice Address - Street 1:3990 OLD TOWN AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2930
Practice Address - Country:US
Practice Address - Phone:760-975-9339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW993981041C0700X
171M00000X
CA993981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator