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General NPI Number Information
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NPI Number | 1225390347
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Entity Type | Individual
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Provider Name | JONATHAN FREDERIC WEBER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 4650 W SUNSET BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90027-6062
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Country | US
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Telephone | 323-361-4606
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Fax |
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Provider Business Mailing Address
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Address Line | 4650 W SUNSET BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90027-6062
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Country | US
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Telephone | 323-361-3386
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Fax | 323-361-1301
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 125-061245
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License Number State | IL
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