Healthcare Provider Details

I. General information

NPI: 1376862177
Provider Name (Legal Business Name): WEENA ERIN JOSHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4077 FIFTH AVE
SAN DIEGO CA
92103-2105
US

IV. Provider business mailing address

1175 PACIFIC BEACH DR UNIT #4
SAN DIEGO CA
92109-5189
US

V. Phone/Fax

Practice location:
  • Phone: 619-260-7046
  • Fax:
Mailing address:
  • Phone: 805-990-5924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA91208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: