Provider Demographics
NPI:1063402956
Name:WEINER, STEVEN RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RICHARD
Last Name:WEINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4526
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91313-4526
Mailing Address - Country:US
Mailing Address - Phone:818-703-7595
Mailing Address - Fax:818-703-8417
Practice Address - Street 1:6325 TOPANGA CANYON BLVD
Practice Address - Street 2:SUITE 224
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2017
Practice Address - Country:US
Practice Address - Phone:818-703-7595
Practice Address - Fax:818-703-8417
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG44483207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6848023Medicaid
CA00G444831Medicaid
CAG44483AMedicare ID - Type UnspecifiedMEDICARE IDENTIFICATION
CA00G444831Medicaid