Provider Demographics
NPI:1215997119
Name:WEISS ISHAI, DEBRA (MD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:WEISS ISHAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 EMBARCADERO RD
Mailing Address - Street 2:STE 100
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-3341
Mailing Address - Country:US
Mailing Address - Phone:925-587-2505
Mailing Address - Fax:925-587-2511
Practice Address - Street 1:1776 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3190
Practice Address - Country:US
Practice Address - Phone:925-933-4383
Practice Address - Fax:925-933-7023
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79075208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics