Provider Demographics
NPI:1104238518
Name:DIANE WEISS, L.AC
Entity type:Organization
Organization Name:DIANE WEISS, L.AC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:818-292-7061
Mailing Address - Street 1:31514 FOXFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4764
Mailing Address - Country:US
Mailing Address - Phone:818-292-7061
Mailing Address - Fax:
Practice Address - Street 1:890 HAMPSHIRE RD STE S
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2875
Practice Address - Country:US
Practice Address - Phone:818-292-7061
Practice Address - Fax:805-379-2779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15969171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty