Provider Demographics
NPI:1861525321
Name:WEINER, ALLEN B (MD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:B
Last Name:WEINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1073 ALVIRA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2626
Mailing Address - Country:US
Mailing Address - Phone:323-934-5912
Mailing Address - Fax:323-965-1955
Practice Address - Street 1:116 N ROBERTSON BLVD
Practice Address - Street 2:SUITE 805
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3103
Practice Address - Country:US
Practice Address - Phone:310-659-2821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23029101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor