Provider Demographics
NPI:1255402608
Name:WEINSTEIN, JOHN R
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:409 N PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 441
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2870
Mailing Address - Country:US
Mailing Address - Phone:714-867-6031
Mailing Address - Fax:714-867-6033
Practice Address - Street 1:12373 LEWIS ST
Practice Address - Street 2:SUITE 103
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4676
Practice Address - Country:US
Practice Address - Phone:714-867-6031
Practice Address - Fax:714-867-6033
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA649362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A649360Medicaid
CA00A649360Medicaid
CAG94750Medicare UPIN
CA00A649360Medicare PIN