Provider Demographics
NPI:1669501946
Name:GERALD M. WEINGARTEN, M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:GERALD M. WEINGARTEN, M.D. A MEDICAL CORPORATION
Other - Org Name:GERALD M. WEINGARTEN, MD, A MEDICAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ISIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-986-1357
Mailing Address - Street 1:16133 VENTURA BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2429
Mailing Address - Country:US
Mailing Address - Phone:818-986-1357
Mailing Address - Fax:818-986-3282
Practice Address - Street 1:16133 VENTURA BLVD STE 400
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2429
Practice Address - Country:US
Practice Address - Phone:818-986-1357
Practice Address - Fax:818-986-3282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31540174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA34611Medicare UPIN