Provider Demographics
NPI:1023155736
Name:DILLARD WATKINS, CHARLENE
Entity type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:
Last Name:DILLARD WATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:
Other - Last Name:DILLARD WATKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1922 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1457
Mailing Address - Country:US
Mailing Address - Phone:408-261-7777
Mailing Address - Fax:408-254-9960
Practice Address - Street 1:1922 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1457
Practice Address - Country:US
Practice Address - Phone:408-261-7777
Practice Address - Fax:408-254-9960
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3464176171M00000X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator