Provider Demographics
NPI:1891761854
Name:LOESCH, WINIFRED MYRNA (MD)
Entity Type:Individual
Prefix:DR
First Name:WINIFRED
Middle Name:MYRNA
Last Name:LOESCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:590 SEARLS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-3043
Mailing Address - Country:US
Mailing Address - Phone:530-798-5003
Mailing Address - Fax:530-271-2338
Practice Address - Street 1:590 SEARLS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-3043
Practice Address - Country:US
Practice Address - Phone:530-798-5003
Practice Address - Fax:530-271-2338
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2010-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC42292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOC422920Medicaid
ZZZ25085ZMedicare ID - Type Unspecified
A37785Medicare UPIN