Provider Demographics
NPI:1891911889
Name:WEISS, DIANE JUDITH (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:JUDITH
Last Name:WEISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 N BEDFORD
Mailing Address - Street 2:STE 404
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210
Mailing Address - Country:US
Mailing Address - Phone:310-273-8448
Mailing Address - Fax:310-550-6824
Practice Address - Street 1:435 N BEDFORD
Practice Address - Street 2:STE 404
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-273-8448
Practice Address - Fax:310-550-6824
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA421852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E15890Medicare UPIN
CAA42185Medicare ID - Type Unspecified