Provider Demographics
NPI:1235444357
Name:TRAVIS WINSOR M D INCORPORATED
Entity Type:Organization
Organization Name:TRAVIS WINSOR M D INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILEY
Authorized Official - Last Name:WINSOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-484-7248
Mailing Address - Street 1:2131 W 3RD ST
Mailing Address - Street 2:ST. VINCENT MEDICAL CENTER DEPT. OF NUCLEAR MEDICINE
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1901
Mailing Address - Country:US
Mailing Address - Phone:213-484-7248
Mailing Address - Fax:213-484-7444
Practice Address - Street 1:2131 W 3RD ST
Practice Address - Street 2:ST. VINCENT MEDICAL CENTER DEPT. OF NUCLEAR MEDICINE
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1901
Practice Address - Country:US
Practice Address - Phone:213-484-7248
Practice Address - Fax:213-484-7444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15320207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G153200Medicaid
CAG15320Medicare PIN
CAA90379Medicare UPIN