Individual provider Active NPI

Winnie Deng, PA-C

  • Physician Assistant
  • Wildomar, CA
National Provider Identifier
1649932864
Registry record updated Oct 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
36485 Inland Valley Dr
Wildomar, CA 92595-9681
Phone
(951) 677-1111
NPI assigned
Oct 6, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

36485 Inland Valley Dr
Wildomar, CA 92595-9681

Mailing address

36485 Inland Valley Dr
Wildomar, CA 92595-9681

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211203002579 CA Practitioner - Physician Assistant 0042600165 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
60170CAMDPharmacist

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1633478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633478400000",
    "number": "1649932864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36485 INLAND VALLEY DR",
            "city": "WILDOMAR",
            "state": "CA",
            "postal_code": "925959681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36485 INLAND VALLEY DR",
            "city": "WILDOMAR",
            "state": "CA",
            "postal_code": "925959681",
            "telephone_number": "951-677-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DENG",
        "first_name": "WINNIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-06",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wildomar, CA

Sources for this page

Verify at the official NPI Registry.