Provider Demographics
NPI:1386117273
Name:WINTER, KIRK
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:WINTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 GARDEN GROVE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-1887
Mailing Address - Country:US
Mailing Address - Phone:714-713-5272
Mailing Address - Fax:
Practice Address - Street 1:3919 W HAZARD AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-2625
Practice Address - Country:US
Practice Address - Phone:800-970-3973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220768164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse