Provider Demographics
NPI:1255525861
Name:BERNARD I WEINSTOCK MD PROFESSIONAL CORP
Entity type:Organization
Organization Name:BERNARD I WEINSTOCK MD PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:IRVING
Authorized Official - Last Name:WEINSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-588-1740
Mailing Address - Street 1:689 SAINT ANDREWS WAY
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-1358
Mailing Address - Country:US
Mailing Address - Phone:805-588-1740
Mailing Address - Fax:805-733-2491
Practice Address - Street 1:1225 N H ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-3301
Practice Address - Country:US
Practice Address - Phone:805-588-1740
Practice Address - Fax:805-733-2491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34920207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G349200Medicaid
CAG34920OtherSTATE LISCENSE
G34920Medicare PIN