Healthcare Provider Details

I. General information

NPI: 1336309897
Provider Name (Legal Business Name): EMILY R WATTERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 KAINS AVE STE 204
ALBANY CA
94706-1270
US

IV. Provider business mailing address

405 KAINS AVE STE 204
ALBANY CA
94706-1270
US

V. Phone/Fax

Practice location:
  • Phone: 510-213-8869
  • Fax: 510-275-0755
Mailing address:
  • Phone: 510-213-8869
  • Fax: 510-275-0755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA112057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: