Provider Demographics
NPI:1154414936
Name:WATSON, DAVID B (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:WATSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16152 BEACH BLVD STE 166
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3843
Mailing Address - Country:US
Mailing Address - Phone:714-665-7072
Mailing Address - Fax:
Practice Address - Street 1:16152 BEACH BLVD STE 166
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3843
Practice Address - Country:US
Practice Address - Phone:714-665-7072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9166103TA0700X
CAPSY 9166103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP9166AMedicare PIN