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General NPI Number Information
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NPI Number | 1457406035
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Entity Type | Individual
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Provider Name | LORRAINE WATSON PA
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 06/13/2019
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Provider Practice Location Address
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Address Line | 4940 VAN NUYS BLVD STE 200
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1741
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Country | US
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Telephone | 818-380-2626
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Fax | 818-380-2620
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Provider Business Mailing Address
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Address Line | 1001 N MARTEL AVE
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90046-6611
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Country | US
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Telephone | 323-436-5019
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 004571
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA19857
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License Number State | CA
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