Healthcare Provider Details

I. General information

NPI: 1407734692
Provider Name (Legal Business Name): IRENE IRIS WEISS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 W METROPOLITAN DR STE 401
ORANGE CA
92868-3506
US

IV. Provider business mailing address

1165 ROSECRANS AVE
FULLERTON CA
92833-1942
US

V. Phone/Fax

Practice location:
  • Phone: 714-935-6065
  • Fax: 714-935-6066
Mailing address:
  • Phone: 714-935-6065
  • Fax: 714-935-6066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number127516
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: