Healthcare Provider Details

I. General information

NPI: 1568699288
Provider Name (Legal Business Name): KAREN LISA WEISS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2009
Last Update Date: 06/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 CAMINO CORRALES
SANTA FE NM
87505-7501
US

IV. Provider business mailing address

1328 CAMINO CORRALES
SANTA FE NM
87505-7501
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-4664
  • Fax: 505-983-7880
Mailing address:
  • Phone: 505-699-4664
  • Fax: 505-983-7880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2000-307
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: