Provider Demographics
NPI:1356511398
Name:SPADARO & WEISZ A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SPADARO & WEISZ A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-493-1964
Mailing Address - Street 1:430 AVENIDA DE LOS ARBOLES STE 201
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3017
Mailing Address - Country:US
Mailing Address - Phone:805-493-1964
Mailing Address - Fax:805-492-0664
Practice Address - Street 1:430 AVENIDA DE LOS ARBOLES STE 201
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-3017
Practice Address - Country:US
Practice Address - Phone:805-493-1964
Practice Address - Fax:805-492-0664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55882208000000X
CAA80637208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty