1699854786 NPI number — WEINER PODIATRY A-PC

Table of content: (NPI 1699854786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699854786 NPI number — WEINER PODIATRY A-PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEINER PODIATRY A-PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699854786
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2410 FIRE MESA ST
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89128-9016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-518-1534
Provider Business Mailing Address Fax Number:
702-931-3944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9260 W SUNSET RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148-4858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-389-5360
Provider Business Practice Location Address Fax Number:
702-829-8420
Provider Enumeration Date:
11/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BARRIOS
Authorized Official First Name:
GABRIELA
Authorized Official Middle Name:
JUDITH
Authorized Official Title or Position:
PERSONAL ASSISTANT
Authorized Official Telephone Number:
702-539-7708

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4800294 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2182331 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1729860 . This is a "UNITED HC" identifier . This identifiers is of the category "OTHER".