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General NPI Number Information
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NPI Number | 1134586456
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Entity Type | Organization
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Legal Business Name | SAN DIEGO ENDOCRINE AND MEDICAL CLINIC
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Dates
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Enumeration Date | 01/17/2016
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Last Update Date | 01/17/2016
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Provider Practice Location Address
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Address Line | 7189 AVIARA DR
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City | CARLSBAD
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State | CA
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Zip | 92011-4901
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Country | US
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Telephone | 760-918-1683
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Fax |
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Provider Business Mailing Address
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Address Line | 7189 AVIARA DR
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City | CARLSBAD
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State | CA
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Zip | 92011-4901
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Country | US
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Telephone | 760-918-1683
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STUART ROLLIN WEISS
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Credential | M.D.
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Telephone | 619-933-2675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | G31180
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License Number State | CA
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