Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080N0001X | Neonatal-Perinatal Doctor | G74628 | CA |
Y | 2080P0203X | Pediatric Critical Care Doctor | G74628 | CA |
NPI | 1013013317 |
---|---|
Provider Name | Irwin Kevin Weiss |
First Address | Los Angeles, CA 90095 |
Second Address | Los Angeles, CA 90095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 30/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G746280 | (05) | CA |
F32931 | (02) | CA |
GR0053510 | (05) | CA |