Individual
DR. LARRY MARK WEISENTHAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD., PHD.
Contact information
Practice address
16512 BURKE LANE, HUNTINGTON BEACH, CA 92647-4538
(714) 596-2100
(714) 596-2110
Mailing address
16512 BURKE LANE, HUNTINGTON BEACH, CA 92647-4538
(714) 596-2100
(714) 596-2110
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
66724
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G41204
MEDICARE PROVIDER #
CA
Enumeration date
07/11/2006
Last updated
05/17/2012
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