Provider Demographics
NPI:1699854786
Name:WEINER PODIATRY A-PC
Entity Type:Organization
Organization Name:WEINER PODIATRY A-PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSONAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:JUDITH
Authorized Official - Last Name:BARRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-539-7708
Mailing Address - Street 1:2410 FIRE MESA ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-9016
Mailing Address - Country:US
Mailing Address - Phone:702-518-1534
Mailing Address - Fax:702-931-3944
Practice Address - Street 1:9260 W SUNSET RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4858
Practice Address - Country:US
Practice Address - Phone:702-389-5360
Practice Address - Fax:702-829-8420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4800294OtherRR MEDICARE
2182331OtherAETNA
1729860OtherUNITED HC
NVV31749Medicare UPIN