Provider Demographics
NPI:1699910992
Name:LEFRANCOIS BOTHELO, DIANA M (DAOM)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:M
Last Name:LEFRANCOIS BOTHELO
Suffix:
Gender:F
Credentials:DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-7800
Mailing Address - Country:US
Mailing Address - Phone:401-624-7379
Mailing Address - Fax:
Practice Address - Street 1:136 MAPLE DR
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-7800
Practice Address - Country:US
Practice Address - Phone:401-624-7379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00256171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
101565900OtherUS DEPT OF LABOR PROVIDER NUMBER