MEDICARE: DR. SANDRA R WEITZ 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	G68113	CA
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	22562	NV

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	:	1952355232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA R WEITZ MD

Provider Business Mailing Address
First Line	:	833 N LAS PALMAS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-3515
Country	:	US
Telephone Number	:	225-773-0473
Fax Number	:

Provider Business Practice Location Address
First Line	:	660 LAKE SHORE BLVD
Second Line	:
City	:	ZEPHYR COVE
State	:	NV
Zip	:	89448
Country	:	US
Telephone Number	:	225-773-0473
Fax Number	:

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	12/15/2023

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Directions to “ DR. SANDRA R WEITZ MD” Practice Location

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