MEDICARE: MR. RALPH ANDREAS WEISS LMFT 36525

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
1	106H00000X	Marriage & Family Therapist	36525	CA

General Provider Information

NPI Number	:	1861528309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RALPH ANDREAS WEISS LMFT 36525

Provider Business Mailing Address
First Line	:	10444 SANTA MONICA BLVD STE 203
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-5088
Country	:	US
Telephone Number	:	310-493-3746
Fax Number	:

Provider Business Practice Location Address
First Line	:	10444 SANTA MONICA BLVD STE 203
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-5088
Country	:	US
Telephone Number	:	310-493-3746
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	09/23/2019

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