Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 17247 | FL |
Y | 2080P0202X | Pediatric Cardiologist | 1285996389 | IL |
NPI | 1285996389 |
---|---|
Provider Name | Kae Watanabe |
First Address | Gainesville, FL 32610-3003 |
Second Address | Gainesville, FL 32610-3003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2012 |
Last Update Date | 18/08/2019 |