Healthcare Provider Details

I. General information

NPI: 1811359318
Provider Name (Legal Business Name): JENNIE WEINKLE GARY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 LINCOLN AVE
PASADENA CA
91103-1324
US

IV. Provider business mailing address

2040 CAMFIELD AVE
COMMERCE CA
90040-1574
US

V. Phone/Fax

Practice location:
  • Phone: 888-499-9303
  • Fax: 626-214-3865
Mailing address:
  • Phone: 888-499-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA155222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: