Provider Demographics
NPI:1205037165
Name:WEISS, KRISTI AMBER (LAC, PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:AMBER
Last Name:WEISS
Suffix:
Gender:F
Credentials:LAC, PA-C
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, PA-C
Mailing Address - Street 1:1840 41ST AVE # 102-131
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2513
Mailing Address - Country:US
Mailing Address - Phone:415-251-7609
Mailing Address - Fax:
Practice Address - Street 1:369 PINE ST STE 422
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3310
Practice Address - Country:US
Practice Address - Phone:415-788-4128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8627171100000X
CA19672363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA134232307OtherTAX ID