Provider Demographics
NPI:1992034789
Name:WATERMAN HEALTH INC
Entity Type:Organization
Organization Name:WATERMAN HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:VISOVSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-885-2464
Mailing Address - Street 1:1396 N WATERMAN
Mailing Address - Street 2:109
Mailing Address - City:SAN BERNARDION
Mailing Address - State:CA
Mailing Address - Zip Code:92404-5313
Mailing Address - Country:US
Mailing Address - Phone:909-885-2464
Mailing Address - Fax:
Practice Address - Street 1:1396 N WATERMAN AVE
Practice Address - Street 2:109
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-5313
Practice Address - Country:US
Practice Address - Phone:909-885-2464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty