Healthcare Provider Details

I. General information

NPI: 1023034733
Provider Name (Legal Business Name): KEITH MITCHELL WEINER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR SUITE 407
ORANGE CA
92868-3854
US

IV. Provider business mailing address

1310 W STEWART DR SUITE 407
ORANGE CA
92868-3854
US

V. Phone/Fax

Practice location:
  • Phone: 714-538-8887
  • Fax: 714-538-6672
Mailing address:
  • Phone: 714-538-8887
  • Fax: 714-538-6672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberG53493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: