Dianne Bohr, LMT
Individual provider Active NPI Contractor · Santa Rosa, CA
NPI 1194897637 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1194897637
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 10852 (OR)
- Practice address
- 3452 Mendocino Ave # B
Santa Rosa, CA 95403-2221 - Phone
- (707) 206-8702
- NPI assigned
- Nov 13, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10852 | OR | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 10852 | OR | Yes |
Addresses
Primary practice location
3452 Mendocino Ave # B
Santa Rosa, CA 95403-2221
Mailing address
PO Box 1202
Santa Rosa, CA 95402-1202
Phone (707) 206-8702
Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.