Provider Demographics
NPI:1992737951
Name:WEINSTEIN, PHYLLIS ANN (DPM)
Entity type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:ANN
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4003213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA480032903OtherRAILROAD MEDICARE
CA000E40030OtherBLUE SHIELD
CA000E40030Medicaid
CA480032903OtherRAILROAD MEDICARE
U61994Medicare UPIN
CA000E40030Medicaid