Provider Demographics
NPI:1477969525
Name:WEISE, ROBERT MAXWELL (MS, MA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MAXWELL
Last Name:WEISE
Suffix:
Gender:M
Credentials:MS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 4TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2332
Mailing Address - Country:US
Mailing Address - Phone:310-394-9871
Mailing Address - Fax:
Practice Address - Street 1:1527 4TH ST FL 2
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2332
Practice Address - Country:US
Practice Address - Phone:310-394-9871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program