Healthcare Provider Details

I. General information

NPI: 1811491327
Provider Name (Legal Business Name): TAMEKA TANYEKA WATSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 06/14/2025
Certification Date: 06/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

IV. Provider business mailing address

1921 S UNION ST UNIT 3020
ANAHEIM CA
92805-6743
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-4373
  • Fax: 714-509-7800
Mailing address:
  • Phone: 310-220-9718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA165674
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: