1023189008 NPI number — MR. JOHN ROBERT WINCKLER M.A., MFT

Table of content: MR. JOHN ROBERT WINCKLER M.A., MFT (NPI 1023189008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023189008 NPI number — MR. JOHN ROBERT WINCKLER M.A., MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINCKLER
Provider First Name:
JOHN
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.A., MFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023189008
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 W JULIAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95126-2719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-292-9353
Provider Business Mailing Address Fax Number:
408-287-3104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 W JULIAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95126-2719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-292-9353
Provider Business Practice Location Address Fax Number:
408-287-3104
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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