Provider Demographics
NPI:1760647283
Name:FREDRIC E WEISS INC
Entity Type:Organization
Organization Name:FREDRIC E WEISS INC
Other - Org Name:FREDRIC E. WEISS M.D. INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-501-4277
Mailing Address - Street 1:16311 VENTURA BLVD
Mailing Address - Street 2:1175
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4359
Mailing Address - Country:US
Mailing Address - Phone:818-501-4277
Mailing Address - Fax:818-501-3113
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:1175
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4359
Practice Address - Country:US
Practice Address - Phone:818-501-4277
Practice Address - Fax:818-501-3113
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREDRIC E. WEISS M.D. INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-24
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29963207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG299631OtherBLUE SHIELD
CA00G299631Medicaid
CAG299631OtherBLUE CROSS
CAAY630Medicare PIN