Organization
BRIAN I. WATANABE, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN I. WATANABE M.D. (PRESIDENT / OWNER)
(949) 770-9300
Entity
Organization
Contact information
Practice address
24953 PASEO DE VALENCIA, SUITE 15C, LAGUNA HILLS, CA 92653-4342
(949) 770-9300
(949) 770-9310
Mailing address
24953 PASEO DE VALENCIA, SUITE 15C, LAGUNA HILLS, CA 92653-4342
(949) 770-9300
(949) 770-9310
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
G83423
CA
2086S0129X
Vascular Surgery Physician
Primary
G83423
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1831262203
INDIVIDUAL NPI
CA
01
—
GM680A
MEDICARE PTAN
CA
Enumeration date
12/13/2009
Last updated
04/08/2013
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