Provider Demographics
NPI:1689058109
Name:WEINBERGER, PHUONG K (PA)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:K
Last Name:WEINBERGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PHUONG
Other - Middle Name:K
Other - Last Name:KHUU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4801 NW LOOP 410 STE 812
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5351
Mailing Address - Country:US
Mailing Address - Phone:210-614-1234
Mailing Address - Fax:210-475-9806
Practice Address - Street 1:18707 HARDY OAK BLVD STE 225
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4869
Practice Address - Country:US
Practice Address - Phone:210-614-1234
Practice Address - Fax:210-475-9806
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09842363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX348958501Medicaid
TX432981YKQHMedicare PIN