Provider Demographics
NPI:1316725542
Name:WAINSTOCK, MADELINE (MS, MPH, CCRP)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:WAINSTOCK
Suffix:
Gender:F
Credentials:MS, MPH, CCRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 S GRAND AVE APT 804
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-3025
Mailing Address - Country:US
Mailing Address - Phone:310-465-7549
Mailing Address - Fax:
Practice Address - Street 1:255 S GRAND AVE APT 804
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-3025
Practice Address - Country:US
Practice Address - Phone:310-465-7549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist