Individual
KYLE WATANABE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2601 E ROOSEVELT ST, PHOENIX, AZ 85008-4973
(602) 344-5956
Mailing address
2601 E ROOSEVELT ST, PHOENIX, AZ 85008-4973
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
54589
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/02/2015
Last updated
06/20/2019
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