Healthcare Provider Details

I. General information

NPI: 1700746088
Provider Name (Legal Business Name): NAMI WATANABE DNP, MPH, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11425 EL CAMINO REAL
SAN DIEGO CA
92130-2045
US

IV. Provider business mailing address

1319 PUNAHOU ST STE 1180
HONOLULU HI
96826-1089
US

V. Phone/Fax

Practice location:
  • Phone: 858-794-6363
  • Fax:
Mailing address:
  • Phone: 808-949-6611
  • Fax: 808-949-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95039979
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-5330
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: