Provider Demographics
NPI:1558639476
Name:WECKLICH, SHILOH SERENE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SHILOH
Middle Name:SERENE
Last Name:WECKLICH
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:225 EAST SECOND AVENUE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025
Mailing Address - Country:US
Mailing Address - Phone:760-291-6700
Mailing Address - Fax:760-737-7324
Practice Address - Street 1:3142 VISTA WAY STE 100
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3627
Practice Address - Country:US
Practice Address - Phone:760-291-6700
Practice Address - Fax:760-754-3859
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2024-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA21992363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical