Provider Demographics
NPI:1821691858
Name:WATTREE, BYRON
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:
Last Name:WATTREE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9491 PITTSBURGH AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-9022
Mailing Address - Country:US
Mailing Address - Phone:909-476-2023
Mailing Address - Fax:
Practice Address - Street 1:9491 PITTSBURGH AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-9022
Practice Address - Country:US
Practice Address - Phone:909-476-2023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA202368III101YA0400X
CAA3123195101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)