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General NPI Number Information
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NPI Number | 1366577744
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Entity Type | Organization
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Legal Business Name | JOHN C WEAVER MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 204 S ATLANTIC BLVD SUITE 2
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City | LOS ANGELES
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State | CA
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Zip | 90022-1755
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Country | US
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Telephone | 323-724-8164
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Fax | 323-724-9207
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Provider Business Mailing Address
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Address Line | PO BOX 424
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City | CULVER CITY
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State | CA
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Zip | 90232-0424
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Country | US
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Telephone | 323-724-8164
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Fax | 323-724-9207
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN C WEAVER
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Credential | M.D.
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Telephone | 323-724-8164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G35959
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License Number State | CA
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