Healthcare Provider Details

I. General information

NPI: 1346668241
Provider Name (Legal Business Name): KRISTINE DIONISIO WATFORD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2014
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 BLOSSOM HILL ROAD SUITE 10
SAN JOSE CA
95124-6350
US

IV. Provider business mailing address

1604 BLOSSOM HILL ROAD SUITE 10
SAN JOSE CA
95124-6350
US

V. Phone/Fax

Practice location:
  • Phone: 408-528-8833
  • Fax:
Mailing address:
  • Phone: 408-528-8833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA153834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: