Provider Demographics
NPI:1255523312
Name:BERNARD WEINTRAUB MD INC
Entity type:Organization
Organization Name:BERNARD WEINTRAUB MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ISHIBASHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-453-4780
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36942207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1104931773OtherNPI
CA00G369420Medicaid
CAA46874Medicare UPIN
CA1104931773OtherNPI