# JOHN C WEAVER MD A PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366577744
- **Authorized official:** DR. JOHN C WEAVER M.D. (PRESIDENT)
- **Authorized official phone:** (323) 724-8164

## Contact information

- **Practice address:** 204 S ATLANTIC BLVD, SUITE 2, LOS ANGELES, CA 90022-1755
- **Practice address phone:** (323) 724-8164
- **Practice address fax:** (323) 724-9207
- **Mailing address:** PO BOX 424, CULVER CITY, CA 90232-0424
- **Mailing address phone:** (323) 724-8164
- **Mailing address fax:** (323) 724-9207

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | G35959 | CA | Yes |

## Other

- **Enumeration date:** 02/23/2007
- **Last updated:** 08/22/2020