Healthcare Provider Details

I. General information

NPI: 1932384740
Provider Name (Legal Business Name): WEINTRAUB & WILMER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 4TH STREET
SANTA MONICA CA
90401-1301
US

IV. Provider business mailing address

1355 4TH ST
SANTA MONICA CA
90401-1301
US

V. Phone/Fax

Practice location:
  • Phone: 310-394-1011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7085T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number7085T
License Number StateCA

VIII. Authorized Official

Name: ROBIN WEINTRAUB
Title or Position: ADMINISTRATOR
Credential:
Phone: 310-394-1011