Organization
CHARLES E WEIDMANN MD A PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES ERNEST WEIDMANN M.D. (M.D., OWNER)
(818) 781-0232
Entity
Organization
Contact information
Practice address
15243 VANOWEN ST, STE 306, VAN NUYS, CA 91405-3649
(818) 781-0232
(818) 781-4132
Mailing address
15243 VANOWEN ST, STE 306, VAN NUYS, CA 91405-3605
(818) 781-0232
(818) 781-4132
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
G48620
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G486200
—
CA
Enumeration date
12/12/2007
Last updated
08/17/2011
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