Provider Demographics
NPI:1053060988
Name:WEISBERG, JAKE ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:JAKE
Middle Name:ANTHONY
Last Name:WEISBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3264 COPLEY ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2670
Mailing Address - Country:US
Mailing Address - Phone:805-404-8018
Mailing Address - Fax:
Practice Address - Street 1:101 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2307
Practice Address - Country:US
Practice Address - Phone:509-474-3020
Practice Address - Fax:509-474-5316
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-19
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program