Provider Demographics
NPI:1821436221
Name:WEINBERG, MIA KAUFMANN (LAC)
Entity Type:Individual
Prefix:MRS
First Name:MIA
Middle Name:KAUFMANN
Last Name:WEINBERG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1711
Mailing Address - Country:US
Mailing Address - Phone:415-730-3478
Mailing Address - Fax:
Practice Address - Street 1:415 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1711
Practice Address - Country:US
Practice Address - Phone:415-730-3478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14277171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist