Provider Demographics
NPI:1841293305
Name:WEISSMAN, ROBERT J (AUD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:WEISSMAN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50735
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91115-0735
Mailing Address - Country:US
Mailing Address - Phone:626-796-9510
Mailing Address - Fax:626-796-9520
Practice Address - Street 1:50 ALESSANDRO PL
Practice Address - Street 2:SUITE 230
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3149
Practice Address - Country:US
Practice Address - Phone:626-796-9510
Practice Address - Fax:626-796-9520
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2060231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0020600Medicaid
CAAU2060AMedicare ID - Type Unspecified
CAAU2060Medicare ID - Type Unspecified
CAAU0020600Medicaid