Provider Demographics
NPI:1588843486
Name:WILLIAM W WINTERNITZ JR MD INC
Entity Type:Organization
Organization Name:WILLIAM W WINTERNITZ JR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:WINTERNITZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:M D
Authorized Official - Phone:858-487-6440
Mailing Address - Street 1:2330 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-2002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12630 MONTE VISTA RD
Practice Address - Street 2:STE 105
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2526
Practice Address - Country:US
Practice Address - Phone:858-487-6440
Practice Address - Fax:858-487-7281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51348174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51975Medicare UPIN
CAW19243Medicare PIN
CA5665450001Medicare NSC