Provider Demographics
NPI:1003087677
Name:WINKLER, MARK R
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:R
Last Name:WINKLER
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 1:4219 LEIMERT BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-4616
Mailing Address - Country:US
Mailing Address - Phone:310-696-1270
Mailing Address - Fax:
Practice Address - Street 1:5701 S EASTERN AVE
Practice Address - Street 2:5500
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-2973
Practice Address - Country:US
Practice Address - Phone:626-395-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner