Provider Demographics
NPI:1811016934
Name:VENN-WATSON MEDICAL CORPORATION
Entity Type:Organization
Organization Name:VENN-WATSON MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:VENN-WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-487-4575
Mailing Address - Street 1:18737 LUNADA PT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-1116
Mailing Address - Country:US
Mailing Address - Phone:858-487-4575
Mailing Address - Fax:858-487-4148
Practice Address - Street 1:3200 4TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5716
Practice Address - Country:US
Practice Address - Phone:619-293-3994
Practice Address - Fax:619-295-7389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22012207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2048917Medicaid
CAW5507Medicare PIN
CAWG22012AMedicare PIN
CA2048917Medicaid