Healthcare Provider Details

I. General information

NPI: 1710298948
Provider Name (Legal Business Name): CHRISTOPHER L WATTS JR. CST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23600 TELO AVE SUITE 180
TORRANCE CA
90505-4035
US

IV. Provider business mailing address

556 W 16TH ST APT 3
SAN PEDRO CA
90731-4756
US

V. Phone/Fax

Practice location:
  • Phone: 310-257-1500
  • Fax:
Mailing address:
  • Phone: 310-900-9620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: