Healthcare Provider Details

I. General information

NPI: 1780221796
Provider Name (Legal Business Name): MICHAEL CHARLES WATUNG DNP, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 INTERNATIONAL BLVD
OAKLAND CA
94601-2228
US

IV. Provider business mailing address

742 W HIGHLAND AVE
SAN BERNARDINO CA
92405-3839
US

V. Phone/Fax

Practice location:
  • Phone: 510-535-4400
  • Fax:
Mailing address:
  • Phone: 909-881-7320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013395
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: