Provider Demographics
NPI:1649373739
Name:WATTS, ELI MARRETTE (MD)
Entity type:Individual
Prefix:DR
First Name:ELI
Middle Name:MARRETTE
Last Name:WATTS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1601 PRECISION PARK LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-1345
Mailing Address - Country:US
Mailing Address - Phone:619-662-4100
Mailing Address - Fax:619-428-7952
Practice Address - Street 1:292 EUCLID AVE STE 210
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-3629
Practice Address - Country:US
Practice Address - Phone:619-662-4100
Practice Address - Fax:619-579-2921
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2022-10-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA79383207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB393243Medicaid
CACB393242Medicaid
CACB393245Medicaid
CACB393244Medicaid