Provider Demographics
NPI:1104999739
Name:WATKINS, HUBERT CHARLES (MD)
Entity type:Individual
Prefix:
First Name:HUBERT
Middle Name:CHARLES
Last Name:WATKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6926 BROCKTON AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506
Mailing Address - Country:US
Mailing Address - Phone:951-683-0540
Mailing Address - Fax:951-683-4516
Practice Address - Street 1:6926 BROCKTON AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506
Practice Address - Country:US
Practice Address - Phone:951-683-0540
Practice Address - Fax:951-683-4516
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G87290207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G87290Medicaid
CA000G87290Medicaid