Healthcare Provider Details

I. General information

NPI: 1790616597
Provider Name (Legal Business Name): SEAN WATSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9047 FLORENCE AVE STE B
DOWNEY CA
90240-3400
US

IV. Provider business mailing address

9047 FLORENCE AVE STE B
DOWNEY CA
90240-3400
US

V. Phone/Fax

Practice location:
  • Phone: 562-291-0559
  • Fax: 310-861-9090
Mailing address:
  • Phone: 562-291-0559
  • Fax: 310-861-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT02569745
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: