Provider Demographics
NPI:1700100906
Name:WEISS, JAMIE M (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:M
Last Name:WEISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:MICHELLE
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3737 MARTIN LUTHER KING JR BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262
Mailing Address - Country:US
Mailing Address - Phone:310-604-0443
Mailing Address - Fax:310-604-3367
Practice Address - Street 1:3737 MARTIN LUTHER KING JR BLVD STE 401
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262
Practice Address - Country:US
Practice Address - Phone:310-604-0443
Practice Address - Fax:310-604-3367
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111783207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease