Healthcare Provider Details

I. General information

NPI: 1164438008
Provider Name (Legal Business Name): CHRISTINE P. WEIGEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SAN ANTONIO RD
MOUNTAIN VIEW CA
94040-1209
US

IV. Provider business mailing address

1691 THE ALAMEDA
SAN JOSE CA
95126-2203
US

V. Phone/Fax

Practice location:
  • Phone: 650-948-0807
  • Fax: 650-948-3319
Mailing address:
  • Phone: 408-795-3619
  • Fax: 408-287-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG50842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: