Provider Demographics
NPI:1396179032
Name:DANIEL DEBOTTIS MD, INC
Entity Type:Organization
Organization Name:DANIEL DEBOTTIS MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DEBOTTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-938-0269
Mailing Address - Street 1:725 W LA VETA AVE
Mailing Address - Street 2:#260
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4403
Mailing Address - Country:US
Mailing Address - Phone:718-938-0269
Mailing Address - Fax:
Practice Address - Street 1:725 W LA VETA AVE
Practice Address - Street 2:#260
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4403
Practice Address - Country:US
Practice Address - Phone:718-938-0269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126199207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty