| Doctor Name: | TAYLOR BOTTARI |
| NPI Number: | 1528452208 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | |
| Business Practice Address: | 208 W Dl Ingram Cannon Afb, NM - 88103 |
| Business Phone Number: | 6026280665 |
| Business Fax Number: | |
| Mailing Address: | 2201 N Norris St Apt A, CLOVIS |
| State: | NM |
| Postal Code: | 881019495 |
| Phone Number: | 6026280665 |
| Fax Number: | |
| NPI Enumeration Date: | 03/20/2015 |
| NPI Last Update Date: | 03/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |