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NPI Code Detail

MEDICARE: DR. MITCHELL WATANABE MD

MEDICARE: DR. MITCHELL WATANABE MD
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
1207Q00000XFamily Medicine PhysicianA44130CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528049996
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MITCHELL WATANABE MD
Provider Business Mailing Address
First Line : 2742 DOW AVE
Second Line :
City : TUSTIN
State : CA
Zip : 92780-7242
Country : US
Telephone Number : 714-665-1600
Fax Number :
Provider Business Practice Location Address
First Line : 1212 W 17TH ST
Second Line :
City : SANTA ANA
State : CA
Zip : 92706-3418
Country : US
Telephone Number : 714-641-7100
Fax Number : 714-434-4500
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 06/21/2011

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Directions to “ DR. MITCHELL WATANABE MD” Practice Location

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