Individual
MARTINA H WIEDAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
300 MEDICAL PLAZA, #B200, LOS ANGELES, CA 90095-0001
(310) 794-1195
(310) 794-7491
Mailing address
5767 W CENTURY BLVD, SUITE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
2084N0008X
Neuromuscular Medicine (Psychiatry & Neurology) Physician
A65989
CA
2084N0400X
Neurology Physician
Primary
A65989
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A659890
—
CA
Enumeration date
07/17/2006
Last updated
12/30/2020
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