Provider Demographics
NPI:1073544854
Name:WEISMAN, GILBERT KESTEN (MD)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:KESTEN
Last Name:WEISMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 AQUA VISTA
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-2028
Mailing Address - Country:US
Mailing Address - Phone:510-708-9101
Mailing Address - Fax:510-237-6468
Practice Address - Street 1:13201 SAN PABLO
Practice Address - Street 2:#303
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806
Practice Address - Country:US
Practice Address - Phone:510-708-9101
Practice Address - Fax:510-237-6468
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC273962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C273960Medicare ID - Type UnspecifiedPHYSICIAN
CAA33357Medicare UPIN
A33357Medicare UPIN