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Individual

DAVID A. WATKINS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CMA

Contact information

Practice address
1400 EMELINE AVE, SANTA CRUZ, CA 95060-1976
(831) 454-4170
Mailing address
1400 EMELINE AVE, SANTA CRUZ, CA 95060-1976
(831) 454-4170

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
CCMA-C 4816-04
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
FHC 70042F
MEDI-CAL GROUP NUMBER
CA
01
FHC 70044F
MEDI-CAL GROUP NUMBER
CA
01
ZZZ91891Z
COUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#
CA
01
ZZZ91892Z
COUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#
CA
01
ZZZ92069Z
COUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#
CA
Enumeration date
03/27/2013
Last updated
03/27/2013
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