Provider Demographics
NPI:1952355232
Name:WEITZ, SANDRA R (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:R
Last Name:WEITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 N LAS PALMAS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-3515
Mailing Address - Country:US
Mailing Address - Phone:225-773-0473
Mailing Address - Fax:
Practice Address - Street 1:660 LAKE SHORE BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYR COVE
Practice Address - State:NV
Practice Address - Zip Code:89448
Practice Address - Country:US
Practice Address - Phone:225-773-0473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68113207LP2900X, 207LP2900X
NV22562207LP2900X
LAMD.12502R208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1534030Medicaid
LA1534030Medicaid
LA5A158CS42Medicare PIN