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General NPI Number Information
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NPI Number | 1659124188
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Entity Type | Organization
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Legal Business Name | SAN DIEGO DIETITIANS, PC
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Dates
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Enumeration Date | 04/05/2024
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 817 ARCHER ST
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City | SAN DIEGO
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State | CA
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Zip | 92109-1123
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Country | US
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Telephone | 858-900-4722
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Fax |
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Provider Business Mailing Address
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Address Line | 817 ARCHER ST
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City | SAN DIEGO
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State | CA
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Zip | 92109-1123
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Country | US
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Telephone | 858-699-7069
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Fax |
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Authorized Official
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Title or Position | DIETITIAN AND OWNER
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Name | MITRA WEISSMAN
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Credential | RD, CNSC, CDE
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Telephone | 858-699-7069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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