Individual
ANTONIO BOTTOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6 N MAIN ST, FAIRPORT, NY 14450-1524
(585) 377-6510
Mailing address
21600 OXNARD ST, WOODLAND HILLS, CA 91367-4976
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-17-44971
NY
Other
Enumeration date
01/26/2018
Last updated
01/26/2018
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