Provider Demographics
NPI:1073880142
Name:WATKINS, JOSHUA (CCP)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:WATKINS
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6128 BRASSIE WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-8004
Mailing Address - Country:US
Mailing Address - Phone:530-262-7311
Mailing Address - Fax:
Practice Address - Street 1:2205 HILLTOP DR
Practice Address - Street 2:#9207
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0511
Practice Address - Country:US
Practice Address - Phone:530-225-7579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA049086-1349242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist