Provider Demographics
NPI:1003621764
Name:WEESE, ANDRE DAVID (PRSSS)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:DAVID
Last Name:WEESE
Suffix:
Gender:M
Credentials:PRSSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 N CITRUS AVE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-5073
Mailing Address - Country:US
Mailing Address - Phone:760-840-8851
Mailing Address - Fax:
Practice Address - Street 1:2148 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-7804
Practice Address - Country:US
Practice Address - Phone:760-840-8851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator