Provider Demographics
NPI:1336354059
Name:WEISS, FREDRIC E (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:E
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16311 VENTURA BLVD
Mailing Address - Street 2:SUITE #1175
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2124
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:SUITE #1175
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2124
Practice Address - Country:US
Practice Address - Phone:818-501-4277
Practice Address - Fax:818-501-3113
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG29963207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAY631Medicare PIN
CAA91251Medicare UPIN