Provider Demographics
NPI:1932314408
Name:WATKINS SPINE, INC.
Entity Type:Organization
Organization Name:WATKINS SPINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:310-448-7890
Mailing Address - Street 1:4640 ADMIRALTY WAY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6621
Mailing Address - Country:US
Mailing Address - Phone:310-448-7890
Mailing Address - Fax:310-448-7853
Practice Address - Street 1:4640 ADMIRALTY WAY
Practice Address - Street 2:SUITE 600
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6621
Practice Address - Country:US
Practice Address - Phone:310-448-7890
Practice Address - Fax:310-448-7853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2960692174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952440505-NPIOtherROBERT G. WATKINS III MD
CA1336288992 - NPIOtherROBERT G. WATKINS IV MD
CA1467575472-NPIOtherDAVID CHANG MD
CAA36062Medicare UPIN