MEDICARE: DANIEL WATKINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	344600000X	Taxi	44306E1	CA
2	344600000X	Taxi	C588618	CA

General Provider Information

NPI Number	:	1518437714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL WATKINS

Provider Business Mailing Address
First Line	:	409 JEFFERSON ST
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-3105
Country	:	US
Telephone Number	:	707-763-3393
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 JEFFERSON ST
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-3105
Country	:	US
Telephone Number	:	707-763-3393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2018
Last Update Date	:	06/27/2022

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Directions to “ DANIEL WATKINS ” Practice Location

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