Individual
JEFFERY RAY BOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
298B BERNAL ROAD, SAN JOSE, CA 95119
(408) 638-4744
Mailing address
3356 GULUZZO DR, SAN JOSE, CA 95148-1328
(510) 418-2829
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-IRYJNS
CA
Other
Enumeration date
11/13/2023
Last updated
11/13/2023
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