Healthcare Provider Details

I. General information

NPI: 1881504900
Provider Name (Legal Business Name): ALEXIS L WATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 E ST
SAN DIEGO CA
92102-3332
US

IV. Provider business mailing address

100 PARK PLZ APT 706
SAN DIEGO CA
92101-6818
US

V. Phone/Fax

Practice location:
  • Phone: 619-645-6754
  • Fax:
Mailing address:
  • Phone: 619-278-1099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: