Healthcare Provider Details

I. General information

NPI: 1437470390
Provider Name (Legal Business Name): ANN MICHELLE WATANABE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 W CERRITOS AVE BUILDING 4
ANAHEIM CA
92805-6546
US

IV. Provider business mailing address

160 W CERRITOS AVE BUILDING 4
ANAHEIM CA
92805-6546
US

V. Phone/Fax

Practice location:
  • Phone: 714-687-6740
  • Fax: 714-533-6884
Mailing address:
  • Phone: 714-687-6740
  • Fax: 714-533-6884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: