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General NPI Number Information
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NPI Number | 1629387790
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Entity Type | Organization
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Legal Business Name | MICHAEL J. WATANABE, M.D., APC
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Dates
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Enumeration Date | 10/06/2010
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Last Update Date | 10/06/2010
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Provider Practice Location Address
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Address Line | 24401 CALLE DE LA LOUISA SUITE 102
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3623
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Country | US
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Telephone | 949-859-8551
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Fax | 949-859-3640
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Provider Business Mailing Address
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Address Line | 24401 CALLE DE LA LOUISA SUITE 102
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3623
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Country | US
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Telephone | 949-859-8551
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Fax | 949-859-3640
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL JUN WATANABE
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Credential | M.D.
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Telephone | 949-859-8551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | A29824
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License Number State | CA
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