Provider Demographics
NPI:1568552834
Name:WEINER, CRAIG D (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:D
Last Name:WEINER
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:PO BOX 1202
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-1202
Mailing Address - Country:US
Mailing Address - Phone:916-989-9044
Mailing Address - Fax:916-988-5288
Practice Address - Street 1:4001 J ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3626
Practice Address - Country:US
Practice Address - Phone:916-989-9044
Practice Address - Fax:916-988-5288
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33172207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G331720Medicaid
CA00G331720Medicaid
A45449Medicare UPIN