Provider Demographics
NPI:1679732341
Name:WATKINS, FAITH ANTOINETTE
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:ANTOINETTE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 N HOLLYWOOD WAY
Mailing Address - Street 2:UNIT F
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2540
Mailing Address - Country:US
Mailing Address - Phone:818-239-0112
Mailing Address - Fax:818-239-0244
Practice Address - Street 1:112 HAMILTON PL
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3809
Practice Address - Country:US
Practice Address - Phone:510-452-5437
Practice Address - Fax:510-452-1353
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator