Provider Demographics
NPI:1730162421
Name:WATKINS, ZENJA (MD)
Entity type:Individual
Prefix:DR
First Name:ZENJA
Middle Name:
Last Name:WATKINS
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:PO BOX 2634
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95759-2634
Mailing Address - Country:US
Mailing Address - Phone:916-201-8301
Mailing Address - Fax:
Practice Address - Street 1:9381 E STOCKTON BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-5070
Practice Address - Country:US
Practice Address - Phone:916-682-7523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60596207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A605960Medicaid
CAG85260Medicare UPIN
CA00A605960Medicare PIN
CA00A605960Medicare ID - Type Unspecified