Provider Demographics
NPI:1447329479
Name:WATKIN, SARA ELLEN (M D)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:ELLEN
Last Name:WATKIN
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 WILSHIRE BLVD STE 515
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1051
Mailing Address - Country:US
Mailing Address - Phone:310-820-9820
Mailing Address - Fax:
Practice Address - Street 1:12301 WILSHIRE BLVD STE 515
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1051
Practice Address - Country:US
Practice Address - Phone:310-820-9820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG756102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry