Provider Demographics
NPI:1932178779
Name:WINSTON, WILLIAM (BC-HIS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:WINSTON
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 MARSH ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3326
Mailing Address - Country:US
Mailing Address - Phone:805-547-0955
Mailing Address - Fax:805-547-0965
Practice Address - Street 1:1240 MARSH ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3326
Practice Address - Country:US
Practice Address - Phone:805-547-0955
Practice Address - Fax:805-547-0965
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA3571237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0035710Medicaid
ZZZ57439ZOtherBLUESHIELD