Provider Demographics
NPI:1497245815
Name:BATHAM-GARCIA, DIANE ELIZABETH (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:ELIZABETH
Last Name:BATHAM-GARCIA
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:ELIZABETH
Other - Last Name:BATHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-PC
Mailing Address - Street 1:5971 VENICE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-1713
Mailing Address - Country:US
Mailing Address - Phone:323-857-3856
Mailing Address - Fax:323-857-2337
Practice Address - Street 1:5971 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-1713
Practice Address - Country:US
Practice Address - Phone:323-857-3856
Practice Address - Fax:323-857-2337
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95008821363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics