Provider Demographics
NPI:1376881078
Name:GOTTSCHALK, DIANE KOPEIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:KOPEIKA
Last Name:GOTTSCHALK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10221 WATERIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10221 WATERIDGE CIR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2702
Practice Address - Country:US
Practice Address - Phone:619-578-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2016-06-10
Deactivation Date:2014-02-24
Deactivation Code:
Reactivation Date:2016-06-10
Provider Licenses
StateLicense IDTaxonomies
CAG56136207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine