Healthcare Provider Details

I. General information

NPI: 1477963494
Provider Name (Legal Business Name): ANGELA WEISSE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3367 S MERCY RD STE 205
GILBERT AZ
85297-7604
US

IV. Provider business mailing address

3367 S MERCY RD STE 205
GILBERT AZ
85297-7604
US

V. Phone/Fax

Practice location:
  • Phone: 480-793-7720
  • Fax:
Mailing address:
  • Phone: 480-793-7720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number62967
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: