Healthcare Provider Details

I. General information

NPI: 1912225772
Provider Name (Legal Business Name): JENNIFER D'ANN WATSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 N BROADWAY SUITE 200
SANTA ANA CA
92706-2663
US

IV. Provider business mailing address

4540 VIA BELLA VIS
YORBA LINDA CA
92886-3016
US

V. Phone/Fax

Practice location:
  • Phone: 714-221-6400
  • Fax:
Mailing address:
  • Phone: 562-307-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number697221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: