Provider Demographics
NPI:1003635707
Name:WEITZEL, FREDERIKE SOPHIA
Entity type:Individual
Prefix:
First Name:FREDERIKE
Middle Name:SOPHIA
Last Name:WEITZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4252 MENTONE AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3443
Mailing Address - Country:US
Mailing Address - Phone:650-564-3288
Mailing Address - Fax:
Practice Address - Street 1:4252 MENTONE AVE UNIT A
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3443
Practice Address - Country:US
Practice Address - Phone:650-564-3288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula