Healthcare Provider Details

I. General information

NPI: 1609109503
Provider Name (Legal Business Name): ABIGAIL WEISSMAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15525 POMERADO RD SUITE C5
POWAY CA
92064-2435
US

IV. Provider business mailing address

15525 POMERADO RD SUITE C5
POWAY CA
92064-2435
US

V. Phone/Fax

Practice location:
  • Phone: 619-403-5578
  • Fax: 866-273-9073
Mailing address:
  • Phone: 619-403-5578
  • Fax: 866-273-9073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 27497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: