Healthcare Provider Details

I. General information

NPI: 1649485715
Provider Name (Legal Business Name): CHRISTOPHER S WEINTROB PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 GRIFFIN AVE
LOS ANGELES CA
90031
US

IV. Provider business mailing address

2210 WOODROW ST
DURHAM NC
27705-3271
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-3961
  • Fax: 323-221-3328
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5301
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number26627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: