Provider Demographics
NPI:1245264589
Name:BOTEZAN, DIANA MIRELA (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MIRELA
Last Name:BOTEZAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 FLOWER ST
Mailing Address - Street 2:SUITE 144
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-4144
Mailing Address - Country:US
Mailing Address - Phone:661-326-2248
Mailing Address - Fax:661-872-3366
Practice Address - Street 1:1830 FLOWER ST
Practice Address - Street 2:SUITE 144
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-4144
Practice Address - Country:US
Practice Address - Phone:661-326-2248
Practice Address - Fax:661-872-3366
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA878542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI45445Medicare UPIN