MEDICARE: MS. KRISTEN KELLY WATSON HS2

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1649398199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTEN KELLY WATSON HS2

Provider Business Mailing Address
First Line	:	3845 HARRISON ST APT 214
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-5019
Country	:	US
Telephone Number	:	415-399-3409
Fax Number	:	415-399-3407

Provider Business Practice Location Address
First Line	:	1 YERBA BUENA RD
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94130-1527
Country	:	US
Telephone Number	:	415-399-3408
Fax Number	:

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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