Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | E4043 | CA |
Y | 213ES0103X | Foot & Ankle Surgery | E4043 | CA |
NPI | 1093786998 |
---|---|
Provider Name | Dr. Glenn Michael Weinraub |
First Address | San Leandro, CA 94577-4201 |
Second Address | San Leandro, CA 94577-4201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 04/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009304860 | (05) | VA |