Provider Demographics
NPI:1275731515
Name:WEISS, DANIELLE EVELYN (M,D,)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:EVELYN
Last Name:WEISS
Suffix:
Gender:F
Credentials:M,D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 235841
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92023-5841
Mailing Address - Country:US
Mailing Address - Phone:760-753-3636
Mailing Address - Fax:760-465-2332
Practice Address - Street 1:4407 MANCHESTER AVE
Practice Address - Street 2:STE 101
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4941
Practice Address - Country:US
Practice Address - Phone:760-753-3636
Practice Address - Fax:760-465-2332
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-09
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96446207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine