1306962519 NPI number — JAMES R WEAGLEY, MD, INC.

Table of content: (NPI 1306962519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306962519 NPI number — JAMES R WEAGLEY, MD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES R WEAGLEY, MD, INC.
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:
1306962519
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20280 SORRENTO LN APT 208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTER RANCH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91326-4482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-324-4625
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24355 LYONS AVE
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
NEWHALL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-255-9355
Provider Business Practice Location Address Fax Number:
661-255-7951
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEAGLEY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
818-324-4625

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A046229 , 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)

  • Identifier: A46229 . This is a "MED LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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