Provider Demographics
NPI:1528339462
Name:PETER J WEINGOLD MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:PETER J WEINGOLD MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEINGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-854-0183
Mailing Address - Street 1:12840 RIVERSIDE DR STE 208
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3343
Mailing Address - Country:US
Mailing Address - Phone:310-854-0183
Mailing Address - Fax:310-854-5631
Practice Address - Street 1:12840 RIVERSIDE DR STE 208
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3343
Practice Address - Country:US
Practice Address - Phone:310-854-0183
Practice Address - Fax:310-854-5631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG371952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty