Healthcare Provider Details

I. General information

NPI: 1932813425
Provider Name (Legal Business Name): RACHEL MORIAH WATTERS PA-C, MPH, MHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 SHOREHAM PL STE 100
SAN DIEGO CA
92122-5904
US

IV. Provider business mailing address

5060 SHOREHAM PL STE 100
SAN DIEGO CA
92122-5904
US

V. Phone/Fax

Practice location:
  • Phone: 858-221-0344
  • Fax:
Mailing address:
  • Phone: 858-221-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number62309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: