Healthcare Provider Details

I. General information

NPI: 1154414936
Provider Name (Legal Business Name): DAVID B WATSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16152 BEACH BLVD STE 166
HUNTINGTON BEACH CA
92647-3843
US

IV. Provider business mailing address

16152 BEACH BLVD STE 166
HUNTINGTON BEACH CA
92647-3843
US

V. Phone/Fax

Practice location:
  • Phone: 714-665-7072
  • Fax:
Mailing address:
  • Phone: 714-665-7072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY9166
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPSY 9166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: