Healthcare Provider Details

I. General information

NPI: 1811016934
Provider Name (Legal Business Name): VENN-WATSON MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 4TH AVE SUITE 100
SAN DIEGO CA
92103-5716
US

IV. Provider business mailing address

18737 LUNADA PT
SAN DIEGO CA
92128-1116
US

V. Phone/Fax

Practice location:
  • Phone: 619-293-3994
  • Fax: 619-295-7389
Mailing address:
  • Phone: 858-487-4575
  • Fax: 858-487-4148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG22012
License Number StateCA

VIII. Authorized Official

Name: DR. EDWARD ARTHUR VENN-WATSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 858-487-4575