Provider Demographics
NPI:1639192263
Name:WEISSMAN, ROBERT A (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:WEISSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 WILBUR AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1309
Mailing Address - Country:US
Mailing Address - Phone:818-986-1357
Mailing Address - Fax:818-986-3282
Practice Address - Street 1:5620 WILBUR AVE STE 214
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1309
Practice Address - Country:US
Practice Address - Phone:818-986-1357
Practice Address - Fax:818-986-3282
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG9913174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB58215Medicare UPIN