Provider Demographics
NPI:1275537227
Name:WEINSTEIN, PAUL BENNETT (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:BENNETT
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 1:2240 N HARBOR BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2635
Mailing Address - Country:US
Mailing Address - Phone:714-870-4665
Mailing Address - Fax:714-870-1582
Practice Address - Street 1:2240 N HARBOR BLVD
Practice Address - Street 2:STE 200
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2635
Practice Address - Country:US
Practice Address - Phone:714-870-4665
Practice Address - Fax:714-870-1582
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA637610207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG37610OtherSTATE LICENCE NUMBER
A47157Medicare UPIN