Provider Demographics
NPI:1922314947
Name:J WATTS OFFICE INC
Entity Type:Organization
Organization Name:J WATTS OFFICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WATTS
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:JUANITA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-901-3570
Mailing Address - Street 1:231 E. ALESSANNDRO BLVD
Mailing Address - Street 2:A136
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508
Mailing Address - Country:US
Mailing Address - Phone:951-901-3570
Mailing Address - Fax:
Practice Address - Street 1:4000 FOURTEENTH ST.
Practice Address - Street 2:213
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501
Practice Address - Country:US
Practice Address - Phone:951-901-3570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50758208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty