MEDICARE: DR. DAVID B WATSON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TA0700X	Adult Development & Aging Psychologist	PSY9166	CA
2	103TR0400X	Rehabilitation Psychologist	PSY 9166	CA

General Provider Information

NPI Number	:	1154414936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID B WATSON PH.D.

Provider Business Mailing Address
First Line	:	16152 BEACH BLVD STE 166
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-3843
Country	:	US
Telephone Number	:	714-665-7072
Fax Number	:

Provider Business Practice Location Address
First Line	:	16152 BEACH BLVD STE 166
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-3843
Country	:	US
Telephone Number	:	714-665-7072
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	06/18/2013

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