Healthcare Provider Details

I. General information

NPI: 1992896591
Provider Name (Legal Business Name): WAYNE R. WEBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 FIRESTONE BLVD SUITE # 100
DOWNEY CA
90241-5242
US

IV. Provider business mailing address

3050 E AIRPORT WAY
LONG BEACH CA
90806-2404
US

V. Phone/Fax

Practice location:
  • Phone: 562-862-5121
  • Fax: 562-862-3027
Mailing address:
  • Phone: 562-426-9661
  • Fax: 562-426-4227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC31321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: