Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A48327 | CA |
NPI | 1003846189 |
---|---|
Provider Name | Dr. Ralph Watchi |
First Address | Los Angeles, CA 90029-0160 |
Second Address | Los Angeles, CA 90027-6005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A483272 | (05) | CA |
1426829 | MEDICAL ID NUMBER (01) | CA |
A48327 | MEDICAL STATE LICENSE# (01) | CA |