Provider Demographics
NPI:1104931773
Name:WEINTRAUB, BERNARD S (MD)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:S
Last Name:WEINTRAUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2001 SANTA MONICA BLVD
Mailing Address - Street 2:#660W
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2102
Mailing Address - Country:US
Mailing Address - Phone:310-453-8584
Mailing Address - Fax:310-829-2306
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:#660W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2102
Practice Address - Country:US
Practice Address - Phone:310-453-8584
Practice Address - Fax:310-829-2306
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG36942207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G369420Medicaid
A46874Medicare UPIN
CAG36942Medicare ID - Type Unspecified