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NPI Code Detail

MEDICARE: JORDAN WEISS

MEDICARE: JORDAN WEISS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1043154008
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN WEISS
Provider Business Mailing Address
First Line : 633 N FORMOSA AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90036-1942
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8831 VENICE BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-3223
Country : US
Telephone Number : 310-204-5200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2026
Last Update Date : 04/17/2026

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Directions to “ JORDAN WEISS ” Practice Location

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