Provider Demographics
NPI:1144511049
Name:WATANABE, LLOYD (LLOYD WATANABE)
Entity type:Individual
Prefix:MR
First Name:LLOYD
Middle Name:
Last Name:WATANABE
Suffix:
Gender:M
Credentials:LLOYD WATANABE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 SANTA TERESA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1436
Mailing Address - Country:US
Mailing Address - Phone:408-227-2816
Mailing Address - Fax:408-227-3204
Practice Address - Street 1:6215 SANTA TERESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1436
Practice Address - Country:US
Practice Address - Phone:408-227-2816
Practice Address - Fax:408-227-3204
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist