Individual
DIANE MARIE BOTTICELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
160 CAPP ST, SAN FRANCISCO, CA 94110-1210
(415) 621-1170
Mailing address
3124 INTERNATIONAL BLVD, OAKLAND, CA 94601-2902
(510) 747-3038
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
17222
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811185259
—
CA
Enumeration date
12/05/2016
Last updated
12/05/2016
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