Organization
BLAKE WATTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BLAKE WATTS CPNP, RNFA (ASSISTANT SURGEON)
(858) 922-3145
Entity
Organization
Contact information
Practice address
4123 CREST DR, MANHATTAN BEACH, CA 90266-3068
(858) 922-3145
Mailing address
4123 CREST DR, MANHATTAN BEACH, CA 90266-3068
(858) 922-3145
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
18112
CA
Other
Enumeration date
03/01/2012
Last updated
03/01/2012
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