Provider Demographics
NPI:1841677614
Name:WATSON, RICHARD LOREN (MD, PHD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:LOREN
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD SUITE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-5631
Mailing Address - Country:US
Mailing Address - Phone:103-018-7073
Mailing Address - Fax:310-301-8752
Practice Address - Street 1:200 MEDICAL PLAZA SUITE 365B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1804
Practice Address - Country:US
Practice Address - Phone:310-825-7921
Practice Address - Fax:310-794-6553
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA150391207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease