Basic Information
| Provider Information | |||||||||
| NPI: | 1881917664 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | TAW | ||||||||
| FirstName: | WINSTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5345 LOMA AVE | ||||||||
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| City: | TEMPLE CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917803002 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 13001 RAMONA BLVD | ||||||||
| Address2: | STE. I | ||||||||
| City: | IRWINDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917063752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263373828 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2010 | ||||||||
| LastUpdateDate: | 03/08/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.