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Individual

GERALD WEIZENBACH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RN

Contact information

Practice address
1400 EMELINE AVE, SANTA CRUZ, CA 95060-1976
(831) 454-4170
(831) 454-4663
Mailing address
1400 EMELINE AVE, SANTA CRUZ, CA 95060-1976
(831) 454-4170
(831) 454-4663

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
754650
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
FHC 70042F
SANTA CRUZ COUNTY MEDI-CAL GROUP PTAN#
CA
01
ZZZ91891Z
SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CA
01
ZZZ91892Z
SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CA
01
ZZZ92069Z
SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CA
Enumeration date
12/15/2015
Last updated
12/15/2015
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