Provider Demographics
NPI:1982640496
Name:WEITZBUCH, SANFORD JAY (DPM)
Entity Type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:JAY
Last Name:WEITZBUCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4499 ALTA TUPELO DR
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-2514
Mailing Address - Country:US
Mailing Address - Phone:818-907-5433
Mailing Address - Fax:818-224-4886
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:SUITE 650
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2124
Practice Address - Country:US
Practice Address - Phone:818-907-5433
Practice Address - Fax:818-224-4886
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2393213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E23930Medicaid
CA000E23930Medicaid
CA4710060001Medicare NSC
CAT19193Medicare UPIN