Provider Demographics
NPI:1043247661
Name:WEISS GREEN, CATHY (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:
Last Name:WEISS GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 20TH STREET
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2080
Mailing Address - Country:US
Mailing Address - Phone:310-828-8534
Mailing Address - Fax:310-453-8468
Practice Address - Street 1:1301 20TH STREET
Practice Address - Street 2:SUITE 220
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2080
Practice Address - Country:US
Practice Address - Phone:310-828-8534
Practice Address - Fax:310-453-8468
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70242207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology