Provider Demographics
NPI:1316581846
Name:BOTKISS CENTER FOR RECOVERY
Entity Type:Organization
Organization Name:BOTKISS CENTER FOR RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:HENRI
Authorized Official - Last Name:BOTKISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-291-7100
Mailing Address - Street 1:12625 HIGH BLUFF DR STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2054
Mailing Address - Country:US
Mailing Address - Phone:619-294-4119
Mailing Address - Fax:619-295-5044
Practice Address - Street 1:12625 HIGH BLUFF DR STE 301
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2054
Practice Address - Country:US
Practice Address - Phone:619-291-7100
Practice Address - Fax:619-295-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1881777803OtherPERSONAL NPI