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General NPI Number Information
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NPI Number | 1528339462
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Entity Type | Organization
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Legal Business Name | PETER J WEINGOLD MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/24/2012
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 12840 RIVERSIDE DR STE 208
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-3343
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Country | US
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Telephone | 310-854-0183
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Fax | 310-854-5631
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Provider Business Mailing Address
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Address Line | 12840 RIVERSIDE DR STE 208
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-3343
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Country | US
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Telephone | 310-854-0183
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Fax | 310-854-5631
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Authorized Official
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Title or Position | PRES.
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Name | DR. PETER J WEINGOLD
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Credential | M.D.
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Telephone | 310-854-0183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G37195
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License Number State | CA
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