Provider Demographics
NPI:1932619384
Name:WATSON, SUSANA ROSALES (ND)
Entity Type:Individual
Prefix:DR
First Name:SUSANA
Middle Name:ROSALES
Last Name:WATSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14523 WESTLAKE DR STE 8
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7700
Mailing Address - Country:US
Mailing Address - Phone:503-919-7575
Mailing Address - Fax:503-607-8661
Practice Address - Street 1:14523 WESTLAKE DR STE 8
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7700
Practice Address - Country:US
Practice Address - Phone:503-919-7575
Practice Address - Fax:503-607-8661
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4111175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath