Provider Demographics
NPI:1720145790
Name:WINKELMAN, DANE III
Entity Type:Individual
Prefix:
First Name:DANE
Middle Name:
Last Name:WINKELMAN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39346 PROSPECT DR.
Mailing Address - Street 2:
Mailing Address - City:FOREST FALLS
Mailing Address - State:CA
Mailing Address - Zip Code:92339
Mailing Address - Country:US
Mailing Address - Phone:909-208-0930
Mailing Address - Fax:
Practice Address - Street 1:39346 PROSPECT DR.
Practice Address - Street 2:
Practice Address - City:FOREST FALLS
Practice Address - State:CA
Practice Address - Zip Code:92339
Practice Address - Country:US
Practice Address - Phone:909-208-0930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27167207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G271670OtherMEDI-CAL