Basic Information
| Provider Information | |||||||||
| NPI: | 1932278991 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEAVER | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | LPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 SUNGOLD CT | ||||||||
| Address2: | |||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927801607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497058912 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1900 E. LA PALMA, STE.#101 | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143993480 | ||||||||
| FaxNumber: | 7143993481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | PT20377 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.