Basic Information
| Provider Information | |||||||||
| NPI: | 1427219872 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEISBERG | ||||||||
| FirstName: | SAMI | ||||||||
| MiddleName: | JOY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SCHWARTZ | ||||||||
| OtherFirstName: | SAMI | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7010 E CHAUNCEY LN | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850543117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805855200 | ||||||||
| FaxNumber: | 4805855233 | ||||||||
| Practice Location | |||||||||
| Address1: | 7010 E CHAUNCEY LN | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | PHOENOX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850543117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805855200 | ||||||||
| FaxNumber: | 4805855233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2008 | ||||||||
| LastUpdateDate: | 03/27/2012 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A102908 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 41395 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 477285 | 05 | AZ | MEDICAID |