Individual
KELLY WATKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
520 SUPERIOR AVE, NEWPORT BEACH, CA 92663-3637
(949) 764-7398
Mailing address
325 ESTANCIA, IRVINE, CA 92602-1106
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
95012178
CA
207T00000X
Neurological Surgery Physician
95012178
CA
2084N0400X
Neurology Physician
Primary
95012178
CA
Other
Enumeration date
01/20/2020
Last updated
01/20/2020
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