Provider Demographics
NPI:1205980729
Name:WEINSTEIN, FREDDIE (MD)
Entity type:Individual
Prefix:DR
First Name:FREDDIE
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 SOQUEL DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1705
Mailing Address - Country:US
Mailing Address - Phone:831-462-7507
Mailing Address - Fax:
Practice Address - Street 1:1555 SOQUEL DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1705
Practice Address - Country:US
Practice Address - Phone:831-462-7507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0733622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ92069ZOtherMEDICARE GROUP PTAN#
CAZZZ91892ZOtherMEDICARE GROUP PTAN#
CAZZZ91891ZOtherMEDICARE GROUP PTAN#
CA00G733620Medicaid
CA00G733620Medicare PIN
CAF90723Medicare UPIN