MEDICARE: ALEX WEINSTEIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	B3040984	CA

General Provider Information

NPI Number	:	1053530535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX WEINSTEIN

Provider Business Mailing Address
First Line	:	5906 ETIWANDA AVE UNIT 9
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-1647
Country	:	US
Telephone Number	:	818-609-7529
Fax Number	:

Provider Business Practice Location Address
First Line	:	8745 PARTHENIA PL STE 4
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-5157
Country	:	US
Telephone Number	:	818-895-5992
Fax Number	:	818-895-5502

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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