Provider Demographics
NPI:1437327947
Name:PHILIP B WEINSTEIN M D A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PHILIP B WEINSTEIN M D A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:B
Authorized Official - Last Name:WEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:562-633-3131
Mailing Address - Street 1:16660 PARAMOUNT BLVD
Mailing Address - Street 2:201
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5433
Mailing Address - Country:US
Mailing Address - Phone:562-633-3131
Mailing Address - Fax:562-633-2576
Practice Address - Street 1:16660 PARAMOUNT BLVD
Practice Address - Street 2:201
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5433
Practice Address - Country:US
Practice Address - Phone:562-633-3131
Practice Address - Fax:562-633-2576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31919207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C319190Medicaid
CAA34761Medicare UPIN