Provider Demographics
NPI:1114086394
Name:WEINSTEIN, ELLIOT STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:STEVEN
Last Name:WEINSTEIN
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 1:8283 GROVE AVE
Mailing Address - Street 2:# 203
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3137
Mailing Address - Country:US
Mailing Address - Phone:909-949-8979
Mailing Address - Fax:909-949-0305
Practice Address - Street 1:8283 GROVE AVE
Practice Address - Street 2:# 203
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3137
Practice Address - Country:US
Practice Address - Phone:909-949-8979
Practice Address - Fax:909-949-0305
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA038238208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA382380OtherMEDICAL
CAOOA382380Medicaid
F51568Medicare UPIN