Healthcare Provider Details

I. General information

NPI: 1285553511
Provider Name (Legal Business Name): JONATHAN WEINISCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W CROSS DR STE 509
LITTLETON CO
80123-0761
US

IV. Provider business mailing address

5731 W 92ND AVE APT 109
WESTMINSTER CO
80031-3014
US

V. Phone/Fax

Practice location:
  • Phone: 303-551-9214
  • Fax:
Mailing address:
  • Phone: 970-540-5821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: