Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | 0101038226 | VA |
Y | 208000000X | Pediatrician | 0101038226 | VA |
NPI | 1063835304 |
---|---|
Provider Name | Juan Weiss |
First Address | Manassas, VA 20110 |
Second Address | Manassas, VA 20110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2014 |
Last Update Date | 22/01/2014 |