Provider Demographics
NPI:1033410501
Name:WEISSMAN, LEE (AUD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:WEISSMAN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505A SAN MARIN DRIVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-2684
Mailing Address - Country:US
Mailing Address - Phone:415-456-4302
Mailing Address - Fax:415-480-6705
Practice Address - Street 1:505A SAN MARIN DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-2684
Practice Address - Country:US
Practice Address - Phone:415-456-4302
Practice Address - Fax:415-480-6705
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2748231H00000X, 231HA2400X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFC603YMedicare PIN