Provider Demographics
NPI:1477762060
Name:WATSON, THERESA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:MARIA
Last Name:WATSON
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 1:46-230 AHUI NANI PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4051
Mailing Address - Country:US
Mailing Address - Phone:808-226-4619
Mailing Address - Fax:
Practice Address - Street 1:46-230 AHUI NANI PL
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-4051
Practice Address - Country:US
Practice Address - Phone:808-226-4619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14144208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics