Provider Demographics
NPI:1114939568
Name:WEINSTOCK, BERNARD IRVING (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:IRVING
Last Name:WEINSTOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BERNARD
Other - Middle Name:IRVING
Other - Last Name:WEINSTOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1225 N H ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-3301
Mailing Address - Country:US
Mailing Address - Phone:805-588-1740
Mailing Address - Fax:805-733-2491
Practice Address - Street 1:1225 N H ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-3301
Practice Address - Country:US
Practice Address - Phone:805-588-1740
Practice Address - Fax:805-733-2491
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34920207YX0007X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG34920OtherSTATE LICENSE
CA00G349200Medicaid