Healthcare Provider Details

I. General information

NPI: 1508278946
Provider Name (Legal Business Name): LINDA KAY WATSON DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 COLEMAN AVE
SAN JOSE CA
95110-2000
US

IV. Provider business mailing address

20793 VISTA LOMA
SAN JOSE CA
95120-1222
US

V. Phone/Fax

Practice location:
  • Phone: 408-283-0326
  • Fax:
Mailing address:
  • Phone: 408-309-2780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number20263
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number8063
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: