Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G79375 | CA |
Y | 208600000X | Surgeon | G79375 | CA |
N | 2082S0105X | Plastic Hand Surgeon | G79375 | CA |
N | 2086S0122X | Plastic and Reconstructive Surgery | G79375 | CA |
NPI | 1912913252 |
---|---|
Provider Name | James Paul Watson |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Calabasas, CA 91302-1958 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 29/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G793750 | MEDI-CAL PPIN # (01) | CA |
F55135 | (02) | CA |