Healthcare Provider Details

I. General information

NPI: 1649118092
Provider Name (Legal Business Name): GREGORY AUSTIN WEED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6666 GREEN VALLEY CIR
CULVER CITY CA
90230-7068
US

IV. Provider business mailing address

6565 GREEN VALLEY CIR UNIT 102
CULVER CITY CA
90230-8096
US

V. Phone/Fax

Practice location:
  • Phone: 310-305-8878
  • Fax: 310-846-5278
Mailing address:
  • Phone: 323-401-9522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-DJQEUP
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: