=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760862536
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J WATTOO DO PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2015
-----------------------------------------------------
Last Update Date | 06/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 N RAINBOW BLVD SUITE 300
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89107-1082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-450-1717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3022 S DURANGO DR SUITE 100
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89117-4439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-450-1717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | JAMIEL WATTOO
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 702-450-1717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------