Provider Demographics
NPI:1992835359
Name:WATSON, RAISHAWN
Entity Type:Individual
Prefix:
First Name:RAISHAWN
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11922 ONE HALF WILLOWBROOK AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059
Mailing Address - Country:US
Mailing Address - Phone:310-766-5537
Mailing Address - Fax:
Practice Address - Street 1:3701 WILSHIRE BLVD
Practice Address - Street 2:SUITE 900
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2804
Practice Address - Country:US
Practice Address - Phone:213-637-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator