Provider Demographics
NPI:1912971847
Name:WEIL, JACQUELIN A (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELIN
Middle Name:A
Last Name:WEIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:ARIEL
Other - Last Name:SON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:653 TOWN CENTER DR #514
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0519
Mailing Address - Country:US
Mailing Address - Phone:702-243-2689
Mailing Address - Fax:702-243-2632
Practice Address - Street 1:653 TOWN CENTER DR
Practice Address - Street 2:#514
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0519
Practice Address - Country:US
Practice Address - Phone:702-243-2689
Practice Address - Fax:702-243-2632
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8780207Q00000X
NV12075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX854035Medicare ID - Type Unspecified
TXG37930Medicare UPIN