Provider Demographics
NPI:1962459982
Name:BOTHWELL, MARCELLA R (MD)
Entity Type:Individual
Prefix:
First Name:MARCELLA
Middle Name:R
Last Name:BOTHWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3860 CALLE FORTUNADA
Mailing Address - Street 2:STE #210
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4802
Mailing Address - Country:US
Mailing Address - Phone:858-309-6303
Mailing Address - Fax:858-309-6301
Practice Address - Street 1:3030 CHILDRENS WAY
Practice Address - Street 2:SUITE 402
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4232
Practice Address - Country:US
Practice Address - Phone:858-309-7701
Practice Address - Fax:858-966-8038
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2011-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG87904207YP0228X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology