Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | G87904 | CA |
Y | 207YP0228X | Pediatric Otolaryngology | G87904 | CA |
NPI | 1962459982 |
---|---|
Provider Name | Marcella R. Bothwell |
First Address | San Diego, CA 92123-4802 |
Second Address | San Diego, CA 92123-4232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 16/11/2011 |