# CENTRO MEDICO DEL CARMEN, A MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063621738
- **Authorized official:** DR. THOMAS LEE WATSON M.D. (CEO)
- **Authorized official phone:** (760) 480-9051

## Contact information

- **Practice address:** 303 S JUNIPER ST, ESCONDIDO, CA 92025-4924
- **Practice address phone:** (760) 480-9051
- **Practice address fax:** (760) 480-9054
- **Mailing address:** 303 S JUNIPER ST, ESCONDIDO, CA 92025-4924
- **Mailing address phone:** (760) 480-9051
- **Mailing address fax:** (760) 480-9054

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A52193 | CA | Yes |

## Other

- **Enumeration date:** 05/21/2007
- **Last updated:** 01/22/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00A521930 | — | CA |