1700100906 NPI number — JAMIE M WEISS M.D.

Table of content: JAMIE M WEISS M.D. (NPI 1700100906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700100906 NPI number — JAMIE M WEISS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISS
Provider First Name:
JAMIE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERGER
Provider Other First Name:
JAMIE
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700100906
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3737 MARTIN LUTHER KING JR BLVD STE 401
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-604-0443
Provider Business Mailing Address Fax Number:
310-604-3367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3737 MARTIN LUTHER KING JR BLVD STE 401
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-604-0443
Provider Business Practice Location Address Fax Number:
310-604-3367
Provider Enumeration Date:
03/17/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  A111783 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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