Provider Demographics
NPI:1669552402
Name:WEISS, ALAN (MD, MA(ED))
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD, MA(ED)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 S GRAND AVE
Mailing Address - Street 2:SUITE 375
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3067
Mailing Address - Country:US
Mailing Address - Phone:213-747-5211
Mailing Address - Fax:
Practice Address - Street 1:1414 S GRAND AVE
Practice Address - Street 2:SUITE 375
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3067
Practice Address - Country:US
Practice Address - Phone:213-747-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31574208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery