Provider Demographics
NPI:1861546608
Name:WEISS, DIANA KAREN (PHD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:KAREN
Last Name:WEISS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:KAREN
Other - Last Name:WEISS-WISDOM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:240 9TH ST
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2717
Mailing Address - Country:US
Mailing Address - Phone:858-259-0146
Mailing Address - Fax:
Practice Address - Street 1:240 9TH ST
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2717
Practice Address - Country:US
Practice Address - Phone:858-259-0146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY#12476103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12476Medicare UPIN