Healthcare Provider Details

I. General information

NPI: 1467391292
Provider Name (Legal Business Name): LILLIAN T WATT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2557 MOWRY AVE STE 31
FREMONT CA
94538-1614
US

IV. Provider business mailing address

2557 MOWRY AVE STE 31
FREMONT CA
94538-1614
US

V. Phone/Fax

Practice location:
  • Phone: 510-745-0900
  • Fax: 510-745-0901
Mailing address:
  • Phone: 510-745-0900
  • Fax: 510-745-0901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberHA9247
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA9247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: