Healthcare Provider Details

I. General information

NPI: 1083721591
Provider Name (Legal Business Name): DOLLY KERIN WEISSERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DOLLY KERIN WEISSERMAN

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16547 PARK LANE CIR
LOS ANGELES CA
90049-1184
US

IV. Provider business mailing address

1811 WILSHIRE BLVD STE 110
SANTA MONICA CA
90403-5626
US

V. Phone/Fax

Practice location:
  • Phone: 248-980-3655
  • Fax:
Mailing address:
  • Phone: 310-453-9010
  • Fax: 310-828-3661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC56036
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC56036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: