Basic Information
| Provider Information | |||||||||
| NPI: | 1306039326 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEIR | ||||||||
| FirstName: | JAALA | ||||||||
| MiddleName: | DANIELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25500 PORTOLA LOOP | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923542235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098107263 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9707 MAGNOLIA AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925033609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513586858 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2007 | ||||||||
| LastUpdateDate: | 01/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | ASW22897 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.