Healthcare Provider Details

I. General information

NPI: 1992151765
Provider Name (Legal Business Name): JONATHAN WATSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N FLOWER ST
SANTA ANA CA
92703-2361
US

IV. Provider business mailing address

550 N FLOWER ST
SANTA ANA CA
92703-2361
US

V. Phone/Fax

Practice location:
  • Phone: 714-647-4666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA153222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: