Wynn Innovations LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WYNN INNOVATIONS LLC

Doing business as

Wynn Health

Practice address

1621 Shelter Cove Dr
Greenwood, CA 95635-9509

Phone

(916) 996-6377

NPI assigned

Nov 9, 2022

Last updated

Dec 19, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Benjamin Wynn

Title

Owner

Phone

(916) 996-6377

Specialties & licenses 1

Addresses

Other names 1

• Wynn Health Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671408000000",
    "number": "1043928948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1621 SHELTER COVE DR",
            "city": "GREENWOOD",
            "state": "CA",
            "postal_code": "956359509",
            "telephone_number": "916-996-6377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1621 SHELTER COVE DR",
            "city": "GREENWOOD",
            "state": "CA",
            "postal_code": "956359509",
            "telephone_number": "916-996-6377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYNN INNOVATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-09",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A",
        "authorized_official_last_name": "WYNN",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "916-996-6377"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wynn Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wynn Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katryna Nicole Lomas
• Eileen W. Proctor, PH.D.
• Together Behavior Solutions, Inc.
• Suzanne Zahrobsky, LAC

• Family Medicine Physician in Greenwood, CA
• Providers in Greenwood, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.