Healthcare Provider Details

I. General information

NPI: 1912106238
Provider Name (Legal Business Name): LAWRENCE WEINSTEIN, M.D., MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 LINCOLN BLVD SUITE 250
SANTA MONICA CA
90401-1750
US

IV. Provider business mailing address

11150 SANTA MONICA BLVD SUITE 1500
LOS ANGELES CA
90025-3380
US

V. Phone/Fax

Practice location:
  • Phone: 310-496-5505
  • Fax:
Mailing address:
  • Phone: 310-444-4309
  • Fax: 310-444-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHUCK TIMPE
Title or Position: ASSISTANT SECRETARY OF THE CORP
Credential:
Phone: 310-444-4320