Provider Demographics
NPI:1033369046
Name:WEBER, ILYA (ILYA WEBER)
Entity Type:Individual
Prefix:MR
First Name:ILYA
Middle Name:
Last Name:WEBER
Suffix:
Gender:M
Credentials:ILYA WEBER
Other - Prefix:MR
Other - First Name:ILYA
Other - Middle Name:
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ILYA WEBER
Mailing Address - Street 1:1292 PAGE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-3064
Mailing Address - Country:US
Mailing Address - Phone:415-621-2929
Mailing Address - Fax:
Practice Address - Street 1:1292 PAGE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-3064
Practice Address - Country:US
Practice Address - Phone:415-621-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional