Provider Demographics
NPI:1497349914
Name:WATSON, LYDIA ESPIRITU
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ESPIRITU
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 MONITOR RD
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1213
Mailing Address - Country:US
Mailing Address - Phone:503-873-2469
Mailing Address - Fax:
Practice Address - Street 1:316 MONITOR RD
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1213
Practice Address - Country:US
Practice Address - Phone:503-873-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider