Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | G34920 | CA |
NPI | 1114939568 |
---|---|
Provider Name | Bernard Irving Weinstock |
First Address | Lompoc, CA 93436-3301 |
Second Address | Lompoc, CA 93436-3301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 06/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G349200 | (05) | CA |
G34920 | STATE LICENSE (01) | CA |