MEDICARE: DIANE WEISS, L.AC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC15969	CA

General Provider Information

NPI Number	:	1104238518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIANE WEISS, L.AC

Provider Business Mailing Address
First Line	:	31514 FOXFIELD DR
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-4764
Country	:	US
Telephone Number	:	818-292-7061
Fax Number	:

Provider Business Practice Location Address
First Line	:	890 HAMPSHIRE RD STE S
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-2875
Country	:	US
Telephone Number	:	818-292-7061
Fax Number	:	805-379-2779

Authorized Official
Title or Position	:	OWNER
Name	:	DIANE M WEISS
Credential	:	L.AC
Telephone Number	:	818-292-7061

Provider Enumeration Date	:	05/21/2014
Last Update Date	:	06/04/2014

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