Healthcare Provider Details

I. General information

NPI: 1972538353
Provider Name (Legal Business Name): DAVID J WEIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16702 VALLEY VIEW AVE
LA MIRADA CA
90638-5824
US

IV. Provider business mailing address

16702 VALLEY VIEW AVE
LA MIRADA CA
90638-5824
US

V. Phone/Fax

Practice location:
  • Phone: 562-921-0341
  • Fax: 562-404-0266
Mailing address:
  • Phone: 714-367-5360
  • Fax: 714-635-5428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberG54871
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG54871
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG54871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: