Provider Demographics
NPI:1396800488
Name:WEITZMAN, ADAM M (MD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:M
Last Name:WEITZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 CABRILLO AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2867
Mailing Address - Country:US
Mailing Address - Phone:310-543-7779
Mailing Address - Fax:
Practice Address - Street 1:1231 CABRILLO AVE STE 205
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2867
Practice Address - Country:US
Practice Address - Phone:310-543-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121616208VP0014X
PAMT188153207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine