Individual
DOMINIQUE M BOTTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D
Contact information
Practice address
1370 13TH AVE S STE 115, JACKSONVILLE, FL 32250-3206
(904) 202-6390
(904) 390-7388
Mailing address
PO BOX 746656, ATLANTA, GA 30374-6656
(904) 202-5111
(904) 391-5836
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AY2238
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AY2238
STATE LICENSE
FL
Enumeration date
10/29/2018
Last updated
05/18/2022
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