Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 95000258 | CA |
NPI | 1013331685 |
---|---|
Provider Name | Mr. Steffan Matthew Weiner |
First Address | Simi Valley, CA 93065-6700 |
Second Address | Simi Valley, CA 93065-6700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2014 |
Last Update Date | 18/08/2015 |