Provider Demographics
NPI:1003139569
Name:WEAVER, AARON KANE
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:KANE
Last Name:WEAVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-3289
Mailing Address - Country:US
Mailing Address - Phone:310-260-3576
Mailing Address - Fax:
Practice Address - Street 1:1725 MAIN ST
Practice Address - Street 2:
Practice Address - City:SANT MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-3289
Practice Address - Country:US
Practice Address - Phone:310-250-3576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator