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General NPI Number Information
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NPI Number | 1689607749
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Entity Type | Individual
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Provider Name | NICODEMUS MARZETTE WATTS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 12625 HIGH BLUFF DR STE 111
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City | SAN DIEGO
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State | CA
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Zip | 92130-2053
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Country | US
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Telephone | 858-598-5207
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Fax | 858-598-5089
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Provider Business Mailing Address
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Address Line | 12625 HIGH BLUFF DR STE 111
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City | SAN DIEGO
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State | CA
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Zip | 92130-2053
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Country | US
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Telephone | 858-598-5207
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Fax | 858-598-5089
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A88041
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License Number State | CA
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