Provider Demographics
NPI:1841233947
Name:WEINSTEIN, GEOFFREY D (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:D
Last Name:WEINSTEIN
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 1:5725 KEARNY VILLA ROAD
Mailing Address - Street 2:SUITE I
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:858-256-0351
Mailing Address - Fax:582-560-3518
Practice Address - Street 1:3075 HEALTH CENTER DRIVE
Practice Address - Street 2:LEVEL 0
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-939-5010
Practice Address - Fax:858-939-5021
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54109174400000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A541090Medicaid
CAA54109OtherMEDICAL LICENSE
CAA54109OtherMEDICAL LICENSE
CA00A541090Medicaid
CAWA54109GMedicare PIN
CAG01209Medicare UPIN
CAWA54109IMedicare ID - Type UnspecifiedFROST MEDICARE
CAWA54109IMedicare PIN
CAWA54109FMedicare PIN