Provider Demographics
NPI:1881839389
Name:WEYMOUTH, DAVID (CPO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WEYMOUTH
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4583 PINE VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-1871
Mailing Address - Country:US
Mailing Address - Phone:209-474-2646
Mailing Address - Fax:209-333-0624
Practice Address - Street 1:1745 W KETTLEMAN LN
Practice Address - Street 2:SUITE A
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-9287
Practice Address - Country:US
Practice Address - Phone:209-333-2259
Practice Address - Fax:209-333-0624
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPO1776224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist