Healthcare Provider Details

I. General information

NPI: 1568552834
Provider Name (Legal Business Name): CRAIG D WEINER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 J ST
SACRAMENTO CA
95819-3626
US

IV. Provider business mailing address

PO BOX 1202
ORANGEVALE CA
95662-1202
US

V. Phone/Fax

Practice location:
  • Phone: 916-989-9044
  • Fax: 916-988-5288
Mailing address:
  • Phone: 916-989-9044
  • Fax: 916-988-5288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberG33172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: