Provider Demographics
NPI:1902039076
Name:VAYNBERG, ALLA G
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:G
Last Name:VAYNBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10230 28TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-3265
Mailing Address - Country:US
Mailing Address - Phone:763-546-4017
Mailing Address - Fax:763-546-4017
Practice Address - Street 1:10230 28TH AVE N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-3265
Practice Address - Country:US
Practice Address - Phone:763-546-4017
Practice Address - Fax:763-546-4017
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies