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General NPI Number Information
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NPI Number | 1932314408
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Entity Type | Organization
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Legal Business Name | WATKINS SPINE, INC.
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 4640 ADMIRALTY WAY SUITE 600
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6621
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Country | US
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Telephone | 310-448-7890
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Fax | 310-448-7853
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Provider Business Mailing Address
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Address Line | 4640 ADMIRALTY WAY SUITE 600
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6621
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Country | US
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Telephone | 310-448-7890
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Fax | 310-448-7853
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT G WATKINS III
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Credential | M.D.
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Telephone | 310-448-7890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2960692
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License Number State | CA
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