Provider Demographics
NPI:1689607749
Name:WATTS, NICODEMUS MARZETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:NICODEMUS
Middle Name:MARZETTE
Last Name:WATTS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3030 CHILDRENS WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4232
Mailing Address - Country:US
Mailing Address - Phone:858-966-8964
Mailing Address - Fax:858-966-6753
Practice Address - Street 1:3030 CHILDREN'S WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4232
Practice Address - Country:US
Practice Address - Phone:858-966-8964
Practice Address - Fax:858-966-6753
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2011-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA880412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry