Provider Demographics
NPI:1366255796
Name:EVAN K WINOGRAD, M.D., PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:EVAN K WINOGRAD, M.D., PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:WINOGRAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:442-273-5056
Mailing Address - Street 1:6125 PASEO DEL NORTE STE 140
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1119
Mailing Address - Country:US
Mailing Address - Phone:442-273-5056
Mailing Address - Fax:442-333-1277
Practice Address - Street 1:6125 PASEO DEL NORTE STE 140
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1119
Practice Address - Country:US
Practice Address - Phone:470-663-4463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-29
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty