Provider Demographics
NPI:1023545407
Name:BOTTINI, BRANDON ARTHUR (DPM)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:ARTHUR
Last Name:BOTTINI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25576
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2006
Mailing Address - Country:US
Mailing Address - Phone:415-645-4525
Mailing Address - Fax:
Practice Address - Street 1:6600 MERCY CT STE 260
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3190
Practice Address - Country:US
Practice Address - Phone:916-961-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0010266213E00000X
CAE6136213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist