Provider Demographics
NPI:1477841815
Name:ISSAC WEINTROUB MD INC
Entity Type:Organization
Organization Name:ISSAC WEINTROUB MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISSAC
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIBTROUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-787-7484
Mailing Address - Street 1:14540 VICTORY BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1600
Mailing Address - Country:US
Mailing Address - Phone:818-787-7484
Mailing Address - Fax:818-787-7484
Practice Address - Street 1:14540 VICTORY BLVD
Practice Address - Street 2:STE 100
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1600
Practice Address - Country:US
Practice Address - Phone:818-787-7484
Practice Address - Fax:818-787-7484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA252287174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty