Individual
MARIVIC DAYRIT BOTTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
15 CORPORATE DR, TRUMBULL, CT 06611-1351
(203) 452-8322
Mailing address
100 BEARD SAWMILL RD, SHELTON, CT 06484-6150
(203) 452-8322
(203) 452-8326
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
045299
CT
208000000X
Pediatrics Physician
Primary
045299
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
061319954
TAX ID#
CT
Enumeration date
02/02/2007
Last updated
06/18/2024
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