Provider Demographics
NPI:1013037209
Name:DOTIMAS, CORAZON BATACAN (LVN)
Entity Type:Individual
Prefix:MRS
First Name:CORAZON
Middle Name:BATACAN
Last Name:DOTIMAS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26256 ISABELLA PL
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-4905
Mailing Address - Country:US
Mailing Address - Phone:619-229-5400
Mailing Address - Fax:619-229-5439
Practice Address - Street 1:5205 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105
Practice Address - Country:US
Practice Address - Phone:619-229-5400
Practice Address - Fax:619-229-5439
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN175442164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVN175442OtherLVN