Provider Demographics
NPI:1356731905
Name:WEISS, DIANE MICHELLE (L, AC DIPL OM)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MICHELLE
Last Name:WEISS
Suffix:
Gender:F
Credentials:L, AC DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31514 FOXFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4764
Mailing Address - Country:US
Mailing Address - Phone:818-292-7061
Mailing Address - Fax:
Practice Address - Street 1:890 HAMPSHIRE RD
Practice Address - Street 2:SUITE S
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2812
Practice Address - Country:US
Practice Address - Phone:818-292-7061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15969171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist