Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 21161 | CA |
NPI | 1467650002 |
---|---|
Provider Name | Dr. Shirley Ann Watson |
First Address | Culver City, CA 90230-5916 |
Second Address | Culver City, CA 90230-5916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2007 |
Last Update Date | 08/07/2007 |