Healthcare Provider Details

I. General information

NPI: 1740606664
Provider Name (Legal Business Name): AMY ELIZABETH WEIR PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 LANGSDORF DR STE 200
FULLERTON CA
92831-3702
US

IV. Provider business mailing address

23352 VIA BURRIANA
MISSION VIEJO CA
92691-2626
US

V. Phone/Fax

Practice location:
  • Phone: 714-871-9264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY30235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: