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General NPI Number Information
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NPI Number | 1740449925
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Entity Type | Individual
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Provider Name | JESSICA AREN WATKINS DO
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Gender | Female
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 7734 N. 59TH AVE
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City | GLENDALE
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State | AZ
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Zip | 85301
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Country | UM
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Telephone | 602-569-3999
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Fax | 602-569-3887
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Provider Business Mailing Address
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Address Line | 1533 E WILLETTA ST
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City | PHOENIX
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State | AZ
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Zip | 85006-2935
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Country | US
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Telephone | 602-569-3999
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Fax | 602-569-3887
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 20A 10046
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 5028
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License Number State | AZ
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