Provider Demographics
NPI:1427172063
Name:WEINTRAUB, JOSEPH NONE (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:NONE
Last Name:WEINTRAUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:NONE
Other - Last Name:WEINTRAUB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1015 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3703
Mailing Address - Country:US
Mailing Address - Phone:831-426-6884
Mailing Address - Fax:831-469-4099
Practice Address - Street 1:1015 CENTER ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3703
Practice Address - Country:US
Practice Address - Phone:831-426-6884
Practice Address - Fax:831-469-4099
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC331232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA35171Medicare UPIN