MEDICARE: DR. AMANDA PATRICIA WEILER MD

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	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	A90432	CA
2	208000000X	Pediatrics Physician	A90432	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881781375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA PATRICIA WEILER MD

Provider Business Mailing Address
First Line	:	950 S GRAND AVE FL 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3999
Country	:	US
Telephone Number	:	323-669-4346
Fax Number	:

Provider Business Practice Location Address
First Line	:	4618 FOUNTAIN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1830
Country	:	US
Telephone Number	:	323-953-7170
Fax Number	:

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	11/30/2021

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