Healthcare Provider Details

I. General information

NPI: 1063543627
Provider Name (Legal Business Name): WITMER NEONATOLOGY ASSOCIATES,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 WILSHIRE BLVD
LOS ANGELES CA
90017-4810
US

IV. Provider business mailing address

PO BOX 9690
GLENDALE CA
91226-0690
US

V. Phone/Fax

Practice location:
  • Phone: 213-977-4123
  • Fax:
Mailing address:
  • Phone: 818-897-0201
  • Fax: 818-897-0176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberFNP 29985
License Number StateCA

VIII. Authorized Official

Name: DR. BIJAN SIASSI
Title or Position: CO-OWNER
Credential: M.D.
Phone: 323-226-3499