Provider Demographics
NPI:1801901574
Name:WEIN, DARYL A (PA)
Entity type:Individual
Prefix:MR
First Name:DARYL
Middle Name:A
Last Name:WEIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2156
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-5156
Mailing Address - Country:US
Mailing Address - Phone:209-848-2273
Mailing Address - Fax:209-848-0242
Practice Address - Street 1:232 W F ST
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3844
Practice Address - Country:US
Practice Address - Phone:209-848-2273
Practice Address - Fax:209-848-0242
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA15134363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P65607Medicare UPIN
P65607Medicare UPIN