Individual
MS. DIANE S WATANABE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1900 PICO BLVD, SMC DEPT OF ATHLETICS, SANTA MONICA, CA 90405-1628
(310) 434-4314
Mailing address
1900 PICO BLVD, SMC DEPT OF ATHLETICS, SANTA MONICA, CA 90405-1628
(310) 434-4314
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
000080379
—
Other
Enumeration date
04/19/2014
Last updated
04/19/2014
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