=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336469477
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATHAN R. WEBER, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2010
-----------------------------------------------------
Last Update Date | 06/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1752 S VICTORIA AVE SUITE A
-----------------------------------------------------
City | VENTURA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93003-6192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-236-2734
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3116 W MARCH LN SUITE 200
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95219-2369
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-473-6555
-----------------------------------------------------
Fax | 209-473-6544
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | S CORP OWNER
-----------------------------------------------------
Name | NATHAN R. WEBER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 805-236-2734
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | A91196
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------