Provider Demographics
NPI:1801854716
Name:WEINSTEIN, ELLIOT DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:DAVID
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 4TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5918
Mailing Address - Country:US
Mailing Address - Phone:619-297-0251
Mailing Address - Fax:
Practice Address - Street 1:2900 4TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5918
Practice Address - Country:US
Practice Address - Phone:619-297-0251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5282103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP5282Medicare ID - Type UnspecifiedMEDICARE