Provider Demographics
NPI:1619429057
Name:WINKELMAN, WILLEM (ATC, EMT-B)
Entity Type:Individual
Prefix:
First Name:WILLEM
Middle Name:
Last Name:WINKELMAN
Suffix:
Gender:M
Credentials:ATC, EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N COMMONWEALTH AVE
Mailing Address - Street 2:#2166 B
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3602
Mailing Address - Country:US
Mailing Address - Phone:707-971-0071
Mailing Address - Fax:
Practice Address - Street 1:555 N COMMONWEALTH AVE
Practice Address - Street 2:#2166 B
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3602
Practice Address - Country:US
Practice Address - Phone:707-971-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE087476146N00000X
20000214252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic