Individual provider Active NPI

Teresita Repiedad Weinberg, P.A.-C

  • Physician Assistant
  • Winter Haven, FL
National Provider Identifier
1386736452
Registry record updated Jul 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9103792 Issued in FL
Practice address
160 E Lake Howard Dr
Winter Haven, FL 33881-3155
Phone
(863) 299-1251
Fax
(863) 299-7666
NPI assigned
Sep 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9103792 FL Primary

Addresses

Primary practice location

160 E Lake Howard Dr
Winter Haven, FL 33881-3155

Mailing address

160 E Lake Howard Dr
Winter Haven, FL 33881-3155
Phone (863) 299-1251

Other identifiers 1

IdentifierTypeStateIssuer
292676800MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248134400000",
    "number": "1386736452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 E LAKE HOWARD DR",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338813155",
            "telephone_number": "863-299-1251",
            "fax_number": "863-299-7666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 E LAKE HOWARD DR",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338813155",
            "telephone_number": "863-299-1251",
            "fax_number": "863-299-7666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEINBERG",
        "first_name": "TERESITA",
        "middle_name": "REPIEDAD",
        "name_prefix": "Mrs.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2009-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9103792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292676800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winter Haven, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.