MEDICARE: GERALD M WEINGARTEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	C31540	CA

General Provider Information

NPI Number	:	1861415499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD M WEINGARTEN M.D.

Provider Business Mailing Address
First Line	:	16133 VENTURA BLVD
Second Line	:	#400
City	:	ENCINO
State	:	CA
Zip	:	91436-2403
Country	:	US
Telephone Number	:	818-986-1357
Fax Number	:	818-986-3282

Provider Business Practice Location Address
First Line	:	16133 VENTURA BLVD
Second Line	:	#400
City	:	ENCINO
State	:	CA
Zip	:	91436-2403
Country	:	US
Telephone Number	:	818-986-1357
Fax Number	:	818-986-3282

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	02/10/2015

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