Healthcare Provider Details

I. General information

NPI: 1720331994
Provider Name (Legal Business Name): WENDY WEINTROB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 NW ARIZONA AVE SUITE 200
BEND OR
97701-3298
US

IV. Provider business mailing address

701 NW ARIZONA AVE SUITE 200
BEND OR
97701-3298
US

V. Phone/Fax

Practice location:
  • Phone: 541-312-9838
  • Fax: 541-312-9839
Mailing address:
  • Phone: 541-312-9838
  • Fax: 541-312-9839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WENDY WEINTROB
Title or Position: OWNER
Credential: ND, LAC
Phone: 541-312-9838