Provider Demographics
NPI:1285899781
Name:PHYLLIS A. WEINSTEIN DPM, INC.
Entity type:Organization
Organization Name:PHYLLIS A. WEINSTEIN DPM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:626-285-7322
Mailing Address - Street 1:9822 LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-2208
Mailing Address - Country:US
Mailing Address - Phone:626-285-7322
Mailing Address - Fax:626-285-4522
Practice Address - Street 1:9822 LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-2208
Practice Address - Country:US
Practice Address - Phone:626-285-7322
Practice Address - Fax:626-285-4522
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYLLIS A. WEINSTEIN DPM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-23
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4003213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E40030Medicaid
CA000E40030Medicaid
CA5391910001Medicare NSC