Healthcare Provider Details

I. General information

NPI: 1265757959
Provider Name (Legal Business Name): LEWIS R. WEINTRAUB,M.D. A MEDICAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 BALBOA BLVD STE 228
ENCINO CA
91316-1502
US

IV. Provider business mailing address

5400 BALBOA BLVD STE 228
ENCINO CA
91316-1502
US

V. Phone/Fax

Practice location:
  • Phone: 818-783-7277
  • Fax: 818-783-9607
Mailing address:
  • Phone: 818-783-7277
  • Fax: 818-783-9607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberG9352
License Number StateCA

VIII. Authorized Official

Name: DR. LEWIS R WEINTRAUB
Title or Position: OWNER
Credential: MD
Phone: 818-783-7277