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General NPI Number Information
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NPI Number | 1922314947
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Entity Type | Organization
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Legal Business Name | J WATTS OFFICE INC
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Dates
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Enumeration Date | 08/27/2010
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Last Update Date | 08/27/2010
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Provider Practice Location Address
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Address Line | 4000 FOURTEENTH ST. 213
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City | RIVERSIDE
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State | CA
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Zip | 92501
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Country | US
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Telephone | 951-901-3570
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Fax |
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Provider Business Mailing Address
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Address Line | 231 E. ALESSANNDRO BLVD A136
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City | RIVERSIDE
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State | CA
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Zip | 92508
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Country | US
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Telephone | 951-901-3570
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. WATTS LOUISE JUANITA
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Credential | MD
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Telephone | 951-901-3570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G50758
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License Number State | CA
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