Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | G53493 | CA |
NPI | 1023034733 |
---|---|
Provider Name | Keith Mitchell Weiner |
First Address | Orange, CA 92868-3854 |
Second Address | Orange, CA 92868-3854 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |