MEDICARE: WATSON MEDICAL INC

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	207Q00000X	Family Medicine Physician	G52886	CA

General Provider Information

NPI Number	:	1831301845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATSON MEDICAL INC

Provider Business Mailing Address
First Line	:	3201 WILSHIRE BLVD STE 211
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-2337
Country	:	US
Telephone Number	:	310-315-9101
Fax Number	:	310-829-9860

Provider Business Practice Location Address
First Line	:	3201 WILSHIRE BLVD STE 211
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-2337
Country	:	US
Telephone Number	:	310-315-9101
Fax Number	:	310-829-9860

Authorized Official
Title or Position	:	OWNER
Name	:	CYNTHIA M WATSON
Credential	:	MD
Telephone Number	:	310-315-9101

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	10/04/2007

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