Provider Demographics
NPI:1942364708
Name:VAINSHTEIN, ALEXANDER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:VAINSHTEIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 BRIGHTON WAY
Mailing Address - Street 2:SUITE #410
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4703
Mailing Address - Country:US
Mailing Address - Phone:310-274-0657
Mailing Address - Fax:310-274-6083
Practice Address - Street 1:9400 BRIGHTON WAY
Practice Address - Street 2:SUITE #410
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4703
Practice Address - Country:US
Practice Address - Phone:310-274-0657
Practice Address - Fax:310-274-6083
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16835363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18224OtherMEDICARE SUBMITTER NUMBER
CAQ75877Medicare UPIN
CAWPA16835BMedicare PIN