Provider Demographics
NPI:1477649119
Name:WATTS HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:WATTS HEALTHCARE CORPORATION
Other - Org Name:WATTS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-564-4331
Mailing Address - Street 1:10300 COMPTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002
Mailing Address - Country:US
Mailing Address - Phone:323-357-6684
Mailing Address - Fax:
Practice Address - Street 1:10300 COMPTON AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002
Practice Address - Country:US
Practice Address - Phone:323-357-6684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABCP12124GMedicaid
CAFHC70422GMedicaid
CAHAP12124GMedicaid
CAW16988AMedicaid
CAEAP12124GMedicaid
CAFHC12124GMedicaid
CAHAP70422GMedicaid
CAHAP70874GMedicaid
CAFHC70874GMedicaid
CABCP70874GMedicaid
CAHAP70874GMedicaid
CAEAP12124GMedicaid
CA551971Medicare PIN