Provider Demographics
NPI:1639204928
Name:DOTTSB, DIANE MARIE (BS)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:DOTTSB
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 E 112TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-1607
Mailing Address - Country:US
Mailing Address - Phone:310-808-5879
Mailing Address - Fax:
Practice Address - Street 1:919 E 112TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-1607
Practice Address - Country:US
Practice Address - Phone:310-808-5879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health