Provider Demographics
NPI:1396778957
Name:WINSTON, KATHY I (MD)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:I
Last Name:WINSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6090 REDWOOD BLVD, SUITE A
Mailing Address - Street 2:MARIN COMMUNITY CLINIC
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945
Mailing Address - Country:US
Mailing Address - Phone:505-232-1920
Mailing Address - Fax:505-727-9276
Practice Address - Street 1:9101 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111
Practice Address - Country:US
Practice Address - Phone:505-275-4288
Practice Address - Fax:505-275-4203
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2012-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM87167207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM754820Medicaid
NM754820Medicaid
F35120Medicare UPIN