Provider Demographics
NPI:1821456906
Name:WINTERS, JUSTIN (BT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:WINTERS
Suffix:
Gender:M
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9110 SW 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-5367
Mailing Address - Country:US
Mailing Address - Phone:503-784-4431
Mailing Address - Fax:
Practice Address - Street 1:11037 WARNER AVE
Practice Address - Street 2:#339
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4007
Practice Address - Country:US
Practice Address - Phone:800-273-4292
Practice Address - Fax:949-253-4627
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator