Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G54871 | CA |
Y | 208600000X | Surgeon | G54871 | CA |
N | 2086S0105X | Surgery of the Hand | G54871 | CA |
N | 2086S0129X | Vascular Surgeon | G54871 | CA |
NPI | 1972538353 |
---|---|
Provider Name | David J Weil |
First Address | La Mirada, CA 90638-5824 |
Second Address | La Mirada, CA 90638-5824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 03/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G548710 | (05) | CA |
C40128 | (02) |