MEDICARE: DR. NICODEMUS MARZETTE WATTS M.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	2084P0800X	Psychiatry Physician	A88041	CA

General Provider Information

NPI Number	:	1689607749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICODEMUS MARZETTE WATTS M.D.

Provider Business Mailing Address
First Line	:	12625 HIGH BLUFF DR STE 111
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2053
Country	:	US
Telephone Number	:	858-598-5207
Fax Number	:	858-598-5089

Provider Business Practice Location Address
First Line	:	12625 HIGH BLUFF DR STE 111
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2053
Country	:	US
Telephone Number	:	858-598-5207
Fax Number	:	858-598-5089

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	10/07/2025

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