Healthcare Provider Details

I. General information

NPI: 1235204314
Provider Name (Legal Business Name): CARL K WATANABE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#107 PLAZA PROF BLDG 400 EVELYN AVE
ALBANY CA
94706
US

IV. Provider business mailing address

#107 PLAZA PROF BLDG
EL CERRITO CA
94530-4000
US

V. Phone/Fax

Practice location:
  • Phone: 510-524-4040
  • Fax: 510-524-4140
Mailing address:
  • Phone: 510-524-4040
  • Fax: 510-524-4140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG12462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: