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General NPI Number Information
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NPI Number | 1972453975
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Entity Type | Individual
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Provider Name | DESTON MAKOA MITSU WATANABE DC
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Gender | Male
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Dates
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Enumeration Date | 01/29/2026
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 13311 GARDEN GROVE BLVD STE B
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City | GARDEN GROVE
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State | CA
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Zip | 92843-2202
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Country | US
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Telephone | 714-621-0327
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Fax |
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Provider Business Mailing Address
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Address Line | 2710 KELVIN AVE APT 2205
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City | IRVINE
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State | CA
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Zip | 92614-5875
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Country | US
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Telephone |
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Fax |
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC37539
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License Number State | CA
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