Provider Demographics
NPI:1417967464
Name:WEINTRAUB, GERALD DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:DAVID
Last Name:WEINTRAUB
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 1:2201 MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-2328
Mailing Address - Country:US
Mailing Address - Phone:760-827-7410
Mailing Address - Fax:760-827-7425
Practice Address - Street 1:2176 SALK AVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7346
Practice Address - Country:US
Practice Address - Phone:760-827-7410
Practice Address - Fax:760-827-7425
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29151208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G291510Medicaid
CAA43964Medicare UPIN
CAWG29151BMedicare ID - Type Unspecified