Provider Demographics
NPI:1033830161
Name:WINLOCK PEDIATRICS LLC
Entity Type:Organization
Organization Name:WINLOCK PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIOLETA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:470-733-0321
Mailing Address - Street 1:2341 NE WINLOCK WAY
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9258
Mailing Address - Country:US
Mailing Address - Phone:470-733-0321
Mailing Address - Fax:
Practice Address - Street 1:2341 NE WINLOCK WAY
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9258
Practice Address - Country:US
Practice Address - Phone:470-733-0321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60912725OtherSTATE LICENSE