Healthcare Provider Details

I. General information

NPI: 1932278991
Provider Name (Legal Business Name): BARBARA LEE WEAVER LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E. LA PALMA, STE.#101
ANAHEIM CA
92805
US

IV. Provider business mailing address

1040 SUNGOLD CT
TUSTIN CA
92780-1607
US

V. Phone/Fax

Practice location:
  • Phone: 714-399-3480
  • Fax: 714-399-3481
Mailing address:
  • Phone: 949-705-8912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT20377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: