Organization Name: | J WATTS OFFICE INC |
NPI Number: | 1922314947 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WATTS LOUISE JUANITA (MEDICAL DIRECTOR) |
Mailing Address: | 4000 Fourteenth St. 213 Riverside |
State: | CA US |
Postal Code: | 92501 |
Phone Number: | 9519013570 |
Fax Number: | |
NPI Enumeration Date: | 08/27/2010 |
NPI Last Update Date: | 08/27/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | G50758 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |