Provider Demographics
NPI:1790341253
Name:WEISS, MADISON (RN)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 PARK BLVD APT 211
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-5620
Mailing Address - Country:US
Mailing Address - Phone:619-919-9919
Mailing Address - Fax:
Practice Address - Street 1:3250 COUNTRY ROSE CIR
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5708
Practice Address - Country:US
Practice Address - Phone:619-639-7325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95144643163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95144643OtherREGISTERED NURSE