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General NPI Number Information
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NPI Number | 1295170645
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Entity Type | Individual
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Provider Name | DR. GEORGE STANLEY WATKIN
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Gender | Male
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 1835 W REDLANDS BLVD
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City | REDLANDS
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State | CA
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Zip | 92373-3118
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Country | US
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Telephone | 909-890-9054
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Fax |
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Provider Business Mailing Address
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Address Line | 5074 TERO
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City | LAGUNA WOODS
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State | CA
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Zip | 92637-1824
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Country | US
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Telephone | 970-948-3506
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | G48537
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License Number State | CA
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