Provider Demographics
NPI:1770082281
Name:WATSON-CORREA, ROBERT DENNIS
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DENNIS
Last Name:WATSON-CORREA
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 1:79 ALOALO ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5728
Mailing Address - Country:US
Mailing Address - Phone:808-443-9900
Mailing Address - Fax:808-769-4975
Practice Address - Street 1:79 ALOALO ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5728
Practice Address - Country:US
Practice Address - Phone:808-443-9900
Practice Address - Fax:808-769-4975
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle