Provider Demographics
NPI:1073852505
Name:WINTER, JENNIFER NICOLE (EDD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:NICOLE
Last Name:WINTER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18000 STUDEBAKER RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2679
Mailing Address - Country:US
Mailing Address - Phone:858-848-1371
Mailing Address - Fax:
Practice Address - Street 1:18000 STUDEBAKER RD
Practice Address - Street 2:SUITE 700
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2679
Practice Address - Country:US
Practice Address - Phone:858-848-1371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92694106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist