Provider Demographics
NPI:1083615082
Name:WINSTON, LORI DANIELLE (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:DANIELLE
Last Name:WINSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:DANIELLE
Other - Last Name:MASTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:146 HIGH SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221-9793
Mailing Address - Country:US
Mailing Address - Phone:708-288-6679
Mailing Address - Fax:
Practice Address - Street 1:520 W MINERAL KING AVE
Practice Address - Street 2:KAWEAH DELTA HEALTH CARE DISTRICT - SSB 5TH FLOOR
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6142
Practice Address - Country:US
Practice Address - Phone:559-624-5215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112630207P00000X
CAC54788207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI26201Medicare UPIN