Provider Demographics
NPI:1720602980
Name:KOTAS, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:KOTAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 GOODALL AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-4625
Mailing Address - Country:US
Mailing Address - Phone:404-803-6719
Mailing Address - Fax:
Practice Address - Street 1:409 GOODALL AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-4625
Practice Address - Country:US
Practice Address - Phone:404-803-6719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula