Provider Demographics
NPI:1841758984
Name:WEICKERT, MARIA TERESA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
Last Name:WEICKERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WASHINGTON ST STE 600
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2239
Mailing Address - Country:US
Mailing Address - Phone:619-882-9304
Mailing Address - Fax:619-269-0674
Practice Address - Street 1:501 WASHINGTON ST STE 600
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2239
Practice Address - Country:US
Practice Address - Phone:619-882-9304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily