Healthcare Provider Details

I. General information

NPI: 1043247661
Provider Name (Legal Business Name): CATHY WEISS GREEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 20TH STREET SUITE 220
SANTA MONICA CA
90404-2080
US

IV. Provider business mailing address

1301 20TH STREET SUITE 220
SANTA MONICA CA
90404-2080
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-8534
  • Fax: 310-453-8468
Mailing address:
  • Phone: 310-828-8534
  • Fax: 310-453-8468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberG70242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: