Provider Demographics
NPI:1912106238
Name:LAWRENCE WEINSTEIN, M.D., MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:LAWRENCE WEINSTEIN, M.D., MEDICAL GROUP, INC.
Other - Org Name:THE PROMETA CENTER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY OF THE CORP
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-444-4320
Mailing Address - Street 1:11150 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3380
Mailing Address - Country:US
Mailing Address - Phone:310-444-4309
Mailing Address - Fax:310-444-5300
Practice Address - Street 1:1315 LINCOLN BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1750
Practice Address - Country:US
Practice Address - Phone:310-496-5505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty