Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G49173 | CA |
Y | 208600000X | Surgeon | G49173 | CA |
NPI | 1023004116 |
---|---|
Provider Name | Dr. Joel Andrew Weinstein |
First Address | Watsonville, CA 95077-1885 |
Second Address | Watsonville, CA 95076-2468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G491730 | (05) | CA |
00G491730 | BLUE SHIELD (01) | CA |
A17093 | (02) | CA |
G491730 | LICENSE (01) | CA |