Provider Demographics
NPI:1518964105
Name:WEINBERG, DAVID MARK (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MARK
Last Name:WEINBERG
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 1:3080 BRISTOL STREET
Mailing Address - Street 2:SUITE 150
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7341
Mailing Address - Country:US
Mailing Address - Phone:714-445-0220
Mailing Address - Fax:714-445-0245
Practice Address - Street 1:1041 E YORBA LINDA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3762
Practice Address - Country:US
Practice Address - Phone:714-445-0220
Practice Address - Fax:714-445-0245
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62688207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
F22783Medicare UPIN
G62688Medicare ID - Type Unspecified