Provider Demographics
NPI:1063563542
Name:WEIGEL, JOSEPH P (NP)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:WEIGEL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:
Other - Last Name:WEIGEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:19325 E SWANEE LN
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3257
Mailing Address - Country:US
Mailing Address - Phone:626-332-1551
Mailing Address - Fax:
Practice Address - Street 1:9808 VENICE BLVD
Practice Address - Street 2:#700
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2732
Practice Address - Country:US
Practice Address - Phone:310-945-3350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR.N. 586797363L00000X
CA16725363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMW2045373OtherDEA