Provider Demographics
NPI:1477438760
Name:WATSON, TINA LOU (BSW)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:LOU
Last Name:WATSON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3628 MADISON AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-5070
Mailing Address - Country:US
Mailing Address - Phone:916-969-4805
Mailing Address - Fax:
Practice Address - Street 1:3628 MADISON AVE STE 6
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-5070
Practice Address - Country:US
Practice Address - Phone:916-388-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program