Provider Demographics
NPI:1407118136
Name:WESTON, AMANDA NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:NICOLE
Last Name:WESTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 MEDICAL CENTER CT
Mailing Address - Street 2:SUITE 216
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6600
Mailing Address - Country:US
Mailing Address - Phone:619-623-3000
Mailing Address - Fax:
Practice Address - Street 1:765 MEDICAL CENTER CT
Practice Address - Street 2:SUITE 216
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6600
Practice Address - Country:US
Practice Address - Phone:619-623-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22158363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant