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General NPI Number Information
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NPI Number | 1992141469
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Entity Type | Organization
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Legal Business Name | FRED M WATKINS MD PC
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Dates
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Enumeration Date | 05/10/2013
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Last Update Date | 12/11/2013
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Provider Practice Location Address
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Address Line | 1810 FULLERTON AVE SUITE #104
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City | CORONA
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State | CA
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Zip | 92881-3103
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Country | US
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Telephone | 951-200-6919
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Fax | 951-200-6919
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Provider Business Mailing Address
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Address Line | PO BOX 3098
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City | TORRANCE
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State | CA
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Zip | 90510-3098
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Country | US
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Telephone | 310-792-3914
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Fax | 855-898-4055
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Authorized Official
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Title or Position | PRESIDENT
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Name | FRED WATKINS
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Credential | MD
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Telephone | 310-792-3914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A117467
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License Number State | CA
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