Individual
ELENA VIRGINIA WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11555 1/2 POTRERO RD, BANNING, CA 92220-6946
(951) 849-4761
Mailing address
11555 1/2 POTRERO RD, BANNING, CA 92220-6946
(951) 849-4761
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
D9467848
CA
Other
Enumeration date
12/19/2018
Last updated
12/19/2018
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