Provider Demographics
NPI:1659124188
Name:SAN DIEGO DIETITIANS, PC
Entity Type:Organization
Organization Name:SAN DIEGO DIETITIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CNSC, CDE
Authorized Official - Phone:858-699-7069
Mailing Address - Street 1:817 ARCHER ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1123
Mailing Address - Country:US
Mailing Address - Phone:858-699-7069
Mailing Address - Fax:
Practice Address - Street 1:817 ARCHER ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-1123
Practice Address - Country:US
Practice Address - Phone:858-900-4722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service