Healthcare Provider Details

I. General information

NPI: 1689596389
Provider Name (Legal Business Name): BRIDGET LEANN WATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 LOS GAMOS DR STE 120
SAN RAFAEL CA
94903-1807
US

IV. Provider business mailing address

1789 MILLER CT
PASO ROBLES CA
93446-4651
US

V. Phone/Fax

Practice location:
  • Phone: 415-444-7400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number4203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: