Individual
ANDREW BOTTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
975 S FAIRMONT AVE, LODI, CA 95240-5179
(209) 334-3411
Mailing address
975 S FAIRMONT AVE, LODI, CA 95240-5179
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA62886
CA
Other
Enumeration date
06/19/2023
Last updated
06/19/2023
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