Provider Demographics
NPI:1851385579
Name:WEINER, RICHARD ALAN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:WEINER
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 1:27412 ENTERPRISE CIR W
Mailing Address - Street 2:STE. 100
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-4803
Mailing Address - Country:US
Mailing Address - Phone:951-694-6367
Mailing Address - Fax:951-308-2388
Practice Address - Street 1:27412 ENTERPRISE CIR W
Practice Address - Street 2:STE. 100
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4803
Practice Address - Country:US
Practice Address - Phone:951-694-6367
Practice Address - Fax:951-308-2388
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59209207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G592091Medicare ID - Type Unspecified
F71680Medicare UPIN