Provider Demographics
NPI:1538195797
Name:WATCHER, MELISSA A (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:WATCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20162 SW BIRCH ST STE 250
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0797
Mailing Address - Country:US
Mailing Address - Phone:949-251-0427
Mailing Address - Fax:949-251-0480
Practice Address - Street 1:20162 SW BIRCH ST STE 250
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0797
Practice Address - Country:US
Practice Address - Phone:949-251-0427
Practice Address - Fax:949-251-0480
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71250207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0972082OtherCLIA
CAG71250OtherMEDICAL LICENSE
CA00G712500Medicaid
CAF22381Medicare UPIN
CA00G712500Medicaid