Provider Demographics
NPI:1255685509
Name:WATSON, TAMMY GAY
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:GAY
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 GOLDFINCH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2994
Mailing Address - Country:US
Mailing Address - Phone:858-483-4247
Mailing Address - Fax:858-724-3015
Practice Address - Street 1:3975 GOLDFINCH ST STE 1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2994
Practice Address - Country:US
Practice Address - Phone:858-483-4247
Practice Address - Fax:858-724-3015
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No174400000XOther Service ProvidersSpecialist
No335E00000XSuppliersProsthetic/Orthotic Supplier