Provider Demographics
NPI:1790726511
Name:CHOWWOODS, DIANE YVONNE (DPM)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:YVONNE
Last Name:CHOWWOODS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 CAROL LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4715
Mailing Address - Country:US
Mailing Address - Phone:925-962-9325
Mailing Address - Fax:
Practice Address - Street 1:3260 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-2739
Practice Address - Country:US
Practice Address - Phone:510-601-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3635213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E36351Medicaid
CAT11726Medicare UPIN
CA000E36351Medicare ID - Type Unspecified