Healthcare Provider Details

I. General information

NPI: 1477841815
Provider Name (Legal Business Name): ISSAC WEINTROUB MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14540 VICTORY BLVD STE 100
VAN NUYS CA
91411-1600
US

IV. Provider business mailing address

14540 VICTORY BLVD STE 100
VAN NUYS CA
91411-1600
US

V. Phone/Fax

Practice location:
  • Phone: 818-787-7484
  • Fax: 818-787-7484
Mailing address:
  • Phone: 818-787-7484
  • Fax: 818-787-7484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA252287
License Number StateCA

VIII. Authorized Official

Name: DR. ISSAC WEIBTROUB
Title or Position: FOUNDER
Credential: M.D.
Phone: 818-787-7484