Provider Demographics
NPI:1518430388
Name:WEISS, LAUREN (PHD, CNS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:PHD, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6645 AVENIDA ANDORRA
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-6403
Mailing Address - Country:US
Mailing Address - Phone:619-997-6866
Mailing Address - Fax:
Practice Address - Street 1:7590 FAY AVE STE 204B
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4874
Practice Address - Country:US
Practice Address - Phone:858-255-8056
Practice Address - Fax:858-255-8056
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist