Healthcare Provider Details

I. General information

NPI: 1518964105
Provider Name (Legal Business Name): DAVID MARK WEINBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 E YORBA LINDA BLVD STE 101
PLACENTIA CA
92870-3762
US

IV. Provider business mailing address

3080 BRISTOL STREET SUITE 150
COSTA MESA CA
92626-7341
US

V. Phone/Fax

Practice location:
  • Phone: 714-445-0220
  • Fax: 714-445-0245
Mailing address:
  • Phone: 714-445-0220
  • Fax: 714-445-0245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG62688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: