Healthcare Provider Details

I. General information

NPI: 1508055948
Provider Name (Legal Business Name): PAUL T WEBBER CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 VETERANS AVE SUITE A-744
LOS ANGELES CA
90095-6985
US

IV. Provider business mailing address

2211 MICHIGAN AVE
SANTA MONICA CA
90404-3905
US

V. Phone/Fax

Practice location:
  • Phone: 424-259-8551
  • Fax: 424-259-8554
Mailing address:
  • Phone: 424-259-8551
  • Fax: 530-533-4617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: