Basic Information
| Provider Information | |||||||||
| NPI: | 1851442263 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATANABE | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | K. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1664 N VIRGINIA ST | ||||||||
| Address2: | # MS-1332 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895571332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756828175 | ||||||||
| FaxNumber: | 7753272009 | ||||||||
| Practice Location | |||||||||
| Address1: | 5190 NEIL RD | ||||||||
| Address2: | #215 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895026599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757846388 | ||||||||
| FaxNumber: | 7757841428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2007 | ||||||||
| LastUpdateDate: | 06/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | 7657 | NV | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 002016022 | 05 | NV | MEDICAID |