Healthcare Provider Details

I. General information

NPI: 1770185498
Provider Name (Legal Business Name): NASH DEVEREAU WEINBERG PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 OCEANSIDE BLVD
OCEANSIDE CA
92054-3452
US

IV. Provider business mailing address

7525 METROPOLITAN DR STE 306
SAN DIEGO CA
92108-4404
US

V. Phone/Fax

Practice location:
  • Phone: 844-316-7979
  • Fax: 866-813-1235
Mailing address:
  • Phone: 844-316-7979
  • Fax: 866-813-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT299451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: