Provider Demographics
NPI:1750064630
Name:WATSON, NEVON MAURICE
Entity type:Individual
Prefix:MR
First Name:NEVON
Middle Name:MAURICE
Last Name:WATSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3680 WILSHIRE BLVD # P04-1025
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2707
Mailing Address - Country:US
Mailing Address - Phone:323-633-9766
Mailing Address - Fax:
Practice Address - Street 1:3680 WILSHIRE BLVD # P04-1025
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2707
Practice Address - Country:US
Practice Address - Phone:323-633-9766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator