Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | C175137 | CA |
NPI | 1144463779 |
---|---|
Provider Name | Shannon Watkins |
First Address | San Francisco, CA 94115-3475 |
Second Address | San Francisco, CA 94115-3475 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2009 |
Last Update Date | 09/11/2021 |