Healthcare Provider Details

I. General information

NPI: 1992640874
Provider Name (Legal Business Name): CONRAD WATKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E BARISTO RD APT 4
PALM SPRINGS CA
92262-7150
US

IV. Provider business mailing address

1900 E BARISTO RD APT 4
PALM SPRINGS CA
92262-7150
US

V. Phone/Fax

Practice location:
  • Phone: 760-534-9257
  • Fax:
Mailing address:
  • Phone: 760-534-9257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number9971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: