1639188899 NPI number — HOWARD PAUL WATERS JR. M.D.

Table of content: HOWARD PAUL WATERS JR. M.D. (NPI 1639188899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639188899 NPI number — HOWARD PAUL WATERS JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATERS
Provider First Name:
HOWARD
Provider Middle Name:
PAUL
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639188899
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2475 E WILDWOOD CANYON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDORA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91741-4022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-335-4239
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6485 DAY ST STE 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92507-0926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-653-5291
Provider Business Practice Location Address Fax Number:
951-653-2440
Provider Enumeration Date:
08/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2083X0100X , with the licence number:  A42041 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)