# BRIAN I. WATANABE, M.D., INC.

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

## Provider details

- **NPI number:** 1417286980
- **Authorized official:** DR. BRIAN I. WATANABE M.D. (PRESIDENT / OWNER)
- **Authorized official phone:** (949) 770-9300

## Contact information

- **Practice address:** 24953 PASEO DE VALENCIA, SUITE 15C, LAGUNA HILLS, CA 92653-4342
- **Practice address phone:** (949) 770-9300
- **Practice address fax:** (949) 770-9310
- **Mailing address:** 24953 PASEO DE VALENCIA, SUITE 15C, LAGUNA HILLS, CA 92653-4342
- **Mailing address phone:** (949) 770-9300
- **Mailing address fax:** (949) 770-9310

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | G83423 | CA | — |
| 2086S0129X | Vascular Surgery Physician | G83423 | CA | Yes |

## Other

- **Enumeration date:** 12/13/2009
- **Last updated:** 04/08/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1831262203 | INDIVIDUAL NPI | CA |
| 01 | — | GM680A | MEDICARE PTAN | CA |