Provider Demographics
NPI:1669627808
Name:VALERIE L. WATIKER M.D. INC
Entity type:Organization
Organization Name:VALERIE L. WATIKER M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:WATIKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-360-8383
Mailing Address - Street 1:11693 SAN VICENTE BLVD
Mailing Address - Street 2:#807
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5105
Mailing Address - Country:US
Mailing Address - Phone:310-360-8383
Mailing Address - Fax:310-820-1606
Practice Address - Street 1:11633 SAN VICENTE BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6511
Practice Address - Country:US
Practice Address - Phone:310-360-8383
Practice Address - Fax:310-820-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83345261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care