Provider Demographics
NPI:1255893004
Name:NEUSTEIN, MIA WEITMAN (NP)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:WEITMAN
Last Name:NEUSTEIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12122 ROYAL BIRKDALE ROW UNIT 303W
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4486
Mailing Address - Country:US
Mailing Address - Phone:858-663-3223
Mailing Address - Fax:
Practice Address - Street 1:71777 SAN JACINTO DR STE 202
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4457
Practice Address - Country:US
Practice Address - Phone:888-743-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-166449163W00000X
CA95240569363LW0102X
CA95016859363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse