Healthcare Provider Details

I. General information

NPI: 1699833012
Provider Name (Legal Business Name): JEFFREY SCOTT WEISS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 WASHINGTON ST STE 641
SAN DIEGO CA
92103-2229
US

IV. Provider business mailing address

550 WASHINGTON ST STE 641
SAN DIEGO CA
92103-2229
US

V. Phone/Fax

Practice location:
  • Phone: 619-299-2600
  • Fax: 619-299-3923
Mailing address:
  • Phone: 619-299-2600
  • Fax: 619-299-3923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberC138264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: