Provider Demographics
NPI:1992866487
Name:WATSON, BLANCHE E (MD)
Entity Type:Individual
Prefix:
First Name:BLANCHE
Middle Name:E
Last Name:WATSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:335 N LA BREA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-2517
Practice Address - Country:US
Practice Address - Phone:323-634-3850
Practice Address - Fax:323-938-9958
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60469207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF22466Medicare UPIN
CAWG60469HMedicare ID - Type Unspecified
CAWG60469EMedicare ID - Type Unspecified
CAWG60469FMedicare ID - Type Unspecified
CAWG60469GMedicare ID - Type Unspecified