Provider Demographics
NPI:1134234289
Name:WATSON, DANIEL LOYD (PH D)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LOYD
Last Name:WATSON
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73567 FRED WARING DR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-2573
Mailing Address - Country:US
Mailing Address - Phone:760-837-1188
Mailing Address - Fax:760-340-1913
Practice Address - Street 1:73567 FRED WARING DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2573
Practice Address - Country:US
Practice Address - Phone:760-837-1188
Practice Address - Fax:760-340-1913
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13059103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY130590Medicaid
CAPSY130590Medicaid