Provider Demographics
NPI:1497245815
Name:BATHAM, DIANE ELIZABETH (CPNP-PC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:ELIZABETH
Last Name:BATHAM
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:ELIZABETH
Other - Last Name:BATHAM-GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-PC
Mailing Address - Street 1:9449 IMPERIAL HWY STE 332
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2888
Mailing Address - Country:US
Mailing Address - Phone:562-657-2938
Mailing Address - Fax:562-657-2977
Practice Address - Street 1:9449 IMPERIAL HWY STE 332
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2888
Practice Address - Country:US
Practice Address - Phone:626-572-9385
Practice Address - Fax:562-657-2977
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95008821363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics