Basic Information
| Provider Information | |||||||||
| NPI: | 1770888448 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHAWN R WINNICK M D INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 148 | ||||||||
| Address2: | |||||||||
| City: | CLAREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917110148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099852112 | ||||||||
| FaxNumber: | 9099853411 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 E WASHINGTON ST STE 155 | ||||||||
| Address2: | |||||||||
| City: | COLTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923244196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093702190 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2011 | ||||||||
| LastUpdateDate: | 01/11/2011 | ||||||||
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| AuthorizedOfficialLastName: | WINNICK | ||||||||
| AuthorizedOfficialFirstName: | SHAWN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9099852112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A82311 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.