Provider Demographics
NPI:1851442263
Name:WATANABE, HENRY K (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:K
Last Name:WATANABE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1664 N VIRGINIA ST
Mailing Address - Street 2:# MS-1332
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89557-1332
Mailing Address - Country:US
Mailing Address - Phone:775-682-8175
Mailing Address - Fax:775-327-2009
Practice Address - Street 1:5190 NEIL RD
Practice Address - Street 2:#215
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6599
Practice Address - Country:US
Practice Address - Phone:775-784-6388
Practice Address - Fax:775-784-1428
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2020-06-05
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Provider Licenses
StateLicense IDTaxonomies
NV76572084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016022Medicaid
NV002016022Medicaid
NVC88992Medicare UPIN
NV31406Medicare PIN