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General NPI Number Information
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NPI Number | 1275720856
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Entity Type | Individual
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Provider Name | JASON JOSEPH WATERMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 25821 VERMONT AVE COASTLINE MEDICAL OFFICE - DEPARTMENT OF ORTHOPEDICS
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City | HARBOR CITY
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State | CA
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Zip | 90710-3518
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Country | US
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Telephone | 424-251-7371
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Fax |
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Provider Business Mailing Address
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Address Line | 25821 VERMONT AVE COASTLINE MEDICAL OFFICE - DEPARTMENT OF ORTHOPEDICS
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City | HARBOR CITY
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State | CA
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Zip | 90710-3518
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Country | US
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Telephone | 424-251-7371
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | A108207
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License Number State | CA
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