Provider Demographics
NPI:1043615677
Name:WATTS OQUENDO, ERIKA T (MD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:T
Last Name:WATTS OQUENDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 AVE ASHFORD APT 2102
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1368
Mailing Address - Country:US
Mailing Address - Phone:787-455-7822
Mailing Address - Fax:
Practice Address - Street 1:C8 AVE. GAUTIER BENITEZ
Practice Address - Street 2:COSOLIDATED MALL
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726
Practice Address - Country:US
Practice Address - Phone:787-772-9850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21759208D00000X, 207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program