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General NPI Number Information
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NPI Number | 1669627808
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Entity Type | Organization
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Legal Business Name | VALERIE L. WATIKER M.D. INC
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 11633 SAN VICENTE BLVD SUITE 206
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City | LOS ANGELES
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State | CA
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Zip | 90049-6511
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Country | US
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Telephone | 310-360-8383
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Fax | 310-820-1606
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Provider Business Mailing Address
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Address Line | 11693 SAN VICENTE BLVD #807
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City | LOS ANGELES
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State | CA
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Zip | 90049-5105
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Country | US
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Telephone | 310-360-8383
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Fax | 310-820-1606
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Authorized Official
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Title or Position | CEO
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Name | DR. VALERIE LEIGH WATIKER
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Credential | M.D.
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Telephone | 310-360-8383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A83345
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License Number State | CA
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