Provider Demographics
NPI:1144560616
Name:WATSON, SCOTT BRANDON (NP)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:BRANDON
Last Name:WATSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2690 PACIFIC AVE STE 290
Mailing Address - Street 2:UNITED STATES OF AMERICA
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2631
Mailing Address - Country:US
Mailing Address - Phone:562-595-9799
Mailing Address - Fax:
Practice Address - Street 1:2690 PACIFIC AVE STE 290
Practice Address - Street 2:UNITED STATES OF AMERICA
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2631
Practice Address - Country:US
Practice Address - Phone:562-595-9799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA737951363LA2100X, 364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care