Provider Demographics
NPI:1275970923
Name:WEISZ, SAYULITA STORM
Entity Type:Individual
Prefix:MRS
First Name:SAYULITA
Middle Name:STORM
Last Name:WEISZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4264
Mailing Address - Country:US
Mailing Address - Phone:415-450-0927
Mailing Address - Fax:
Practice Address - Street 1:2255 CHALLENGER WAY
Practice Address - Street 2:SUITE 106
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5423
Practice Address - Country:US
Practice Address - Phone:707-545-4551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor