Provider Demographics
NPI:1639420177
Name:HAL M. WEITZBUCH, M.D. MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HAL M. WEITZBUCH, M.D. MEDICAL CORPORATION
Other - Org Name:CALABASAS DERMATOLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAL
Authorized Official - Middle Name:MARCUS
Authorized Official - Last Name:WEITZBUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS, FAAD
Authorized Official - Phone:818-222-7495
Mailing Address - Street 1:23501 PARK SORRENTO # 216
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1308
Mailing Address - Country:US
Mailing Address - Phone:818-222-7495
Mailing Address - Fax:818-222-7498
Practice Address - Street 1:23501 PARK SORRENTO STE 216
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1308
Practice Address - Country:US
Practice Address - Phone:818-222-7495
Practice Address - Fax:818-222-7498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121615261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty