Provider Demographics
NPI:1477553568
Name:WEINSTEIN, PHILIP B (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:B
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 1:16660 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
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC31919207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C319190Medicaid
A34761Medicare UPIN
CA00C319190Medicaid