Provider Demographics
NPI:1598476590
Name:WATKINS, WRAYLN (CEP, EIM III, NBHWC)
Entity Type:Individual
Prefix:
First Name:WRAYLN
Middle Name:
Last Name:WATKINS
Suffix:
Gender:M
Credentials:CEP, EIM III, NBHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9534 ACKLAY CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5101
Mailing Address - Country:US
Mailing Address - Phone:714-552-8088
Mailing Address - Fax:
Practice Address - Street 1:500 SUPERIOR AVE STE 200
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3659
Practice Address - Country:US
Practice Address - Phone:949-629-2600
Practice Address - Fax:949-629-2601
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-3691502171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach