Provider Demographics
NPI:1013969161
Name:BOTWIN, ALLISON JAMES (MD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:JAMES
Last Name:BOTWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 S FARRELL DR
Mailing Address - Street 2:SUITE A-206
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7963
Mailing Address - Country:US
Mailing Address - Phone:760-778-5355
Mailing Address - Fax:760-778-5358
Practice Address - Street 1:340 S FARRELL DR
Practice Address - Street 2:SUITE A-206
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7963
Practice Address - Country:US
Practice Address - Phone:760-778-5355
Practice Address - Fax:760-778-5358
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA452022084A0401X, 2084P0005X, 2084P0800X, 2084P0802X, 2084P0805X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE30285Medicare UPIN
CA00A452021Medicare ID - Type Unspecified