Provider Demographics
NPI:1326251703
Name:WINELAND, RICHARD E
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:E
Last Name:WINELAND
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 1:1211 W LA PALMA AVE
Mailing Address - Street 2:307
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801
Mailing Address - Country:US
Mailing Address - Phone:714-776-6456
Mailing Address - Fax:714-776-6924
Practice Address - Street 1:1211 W LA PALMA AVE
Practice Address - Street 2:307
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801
Practice Address - Country:US
Practice Address - Phone:714-776-6456
Practice Address - Fax:714-776-6924
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG030924208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG30924AMedicare PIN
CAE91771Medicare UPIN