Healthcare Provider Details

I. General information

NPI: 1285361709
Provider Name (Legal Business Name): SONYA LYNANNE WATSON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL PLAZA DRIVEWAY SUITE B200
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

8770 SHOREHAM DR APT 3
WEST HOLLYWOOD CA
90069-2292
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-1195
  • Fax:
Mailing address:
  • Phone: 530-953-5733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC001607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: