Healthcare Provider Details

I. General information

NPI: 1821199209
Provider Name (Legal Business Name): GERALD BRETT WEISS M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47050 WASHINGTON ST 4202
LA QUINTA CA
92253-2629
US

IV. Provider business mailing address

47050 WASHINGTON ST 4202
LA QUINTA CA
92253-2629
US

V. Phone/Fax

Practice location:
  • Phone: 760-564-7444
  • Fax: 760-564-7422
Mailing address:
  • Phone: 760-564-7444
  • Fax: 760-564-7422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG86691
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG86691
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberG86691
License Number StateCA

VIII. Authorized Official

Name: GERALD BRETT WEISS
Title or Position: DOCTOR/OWNER
Credential: M.D.
Phone: 760-564-7444