Provider Demographics
NPI:1780770560
Name:WEISS, DONALD H (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:H
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 EL CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1020
Mailing Address - Country:US
Mailing Address - Phone:619-284-5622
Mailing Address - Fax:619-284-3160
Practice Address - Street 1:3811 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1020
Practice Address - Country:US
Practice Address - Phone:619-284-5622
Practice Address - Fax:619-284-3160
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC25184207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C251840Medicaid
CADWC25184Medicare ID - Type Unspecified
E47639Medicare UPIN