Provider Demographics
NPI:1457451494
Name:WATTS-WHITE, PAULA A (MD)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:A
Last Name:WATTS-WHITE
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 1:635 ANDERSON RD STE 12A
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-3505
Mailing Address - Country:US
Mailing Address - Phone:530-750-3400
Mailing Address - Fax:530-750-3401
Practice Address - Street 1:635 ANDERSON RD STE 12A
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3505
Practice Address - Country:US
Practice Address - Phone:530-750-3400
Practice Address - Fax:530-750-3401
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55408208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G554080Medicaid
CA00G554080Medicaid
00G554080Medicare ID - Type Unspecified