Provider Demographics
NPI:1336432848
Name:WATKINS, BRUCE RICHARD I (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:RICHARD
Last Name:WATKINS
Suffix:I
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:BRUCE
Other - Middle Name:RICHARD
Other - Last Name:WATKINS
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1314 WESTWOOD BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4928
Mailing Address - Country:US
Mailing Address - Phone:310-475-5977
Mailing Address - Fax:
Practice Address - Street 1:1314 WESTWOOD BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4928
Practice Address - Country:US
Practice Address - Phone:310-475-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4049103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical