Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 3364 | CA |
N | 103K00000X | Behavior Analyst | 3364 | CA |
N | 104100000X | Social Worker | 3364 | CA |
N | 225100000X | Physical Therapist | 3364 | CA |
N | 225C00000X | Rehabilitation Counselor | 3364 | CA |
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 3364 | CA |
NPI | 1124485057 |
---|---|
Provider Name | Christine Weaver |
First Address | San Diego, CA 92101-2955 |
Second Address | San Diego, CA 92101-2955 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2016 |
Last Update Date | 22/01/2016 |