Healthcare Provider Details

I. General information

NPI: 1053530535
Provider Name (Legal Business Name): ALEX WEINSTEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8745 PARTHENIA PL STE 4
NORTH HILLS CA
91343-5157
US

IV. Provider business mailing address

5906 ETIWANDA AVE UNIT 9
TARZANA CA
91356-1647
US

V. Phone/Fax

Practice location:
  • Phone: 818-895-5992
  • Fax: 818-895-5502
Mailing address:
  • Phone: 818-609-7529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberB3040984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: