=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588679260
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEVEN J. WEISS M.D. INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2006
-----------------------------------------------------
Last Update Date | 03/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11480 BROOKSHIRE AVE SUITE #107
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90241-5018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-861-0897
-----------------------------------------------------
Fax | 562-862-2297
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11411 BROOKSHIRE AVE SUITE #401
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90241-5003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-861-0897
-----------------------------------------------------
Fax | 562-862-2297
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STEVEN JEFFREY WEISS IX
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 562-861-0897
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | G39288
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------