Provider Demographics
NPI:1417621830
Name:WEINBERG, ZOE B (PA)
Entity Type:Individual
Prefix:MISS
First Name:ZOE
Middle Name:B
Last Name:WEINBERG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 N NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8600
Mailing Address - Country:US
Mailing Address - Phone:719-776-3750
Mailing Address - Fax:719-776-3751
Practice Address - Street 1:4925 N NEVADA AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8600
Practice Address - Country:US
Practice Address - Phone:719-776-3750
Practice Address - Fax:719-776-3751
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007577363AS0400X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000211130Medicaid