Provider Demographics
NPI:1710939681
Name:WEINERT, CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:WEINERT
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 1:1310 W STEWART DR
Mailing Address - Street 2:SUITE 508
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3854
Mailing Address - Country:US
Mailing Address - Phone:714-633-2111
Mailing Address - Fax:714-633-5615
Practice Address - Street 1:1310 W STEWART DR
Practice Address - Street 2:SUITE 508
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3854
Practice Address - Country:US
Practice Address - Phone:714-633-2111
Practice Address - Fax:714-633-5615
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39051174400000X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G390511OtherMEDI-CAL LEGACY
CAW14179OtherGROUP PTAN
CA00G390510Medicaid
CAWG39051AOtherMEDICARE PTAN
CAWG39051AOtherMEDICARE PTAN