Provider Demographics
NPI:1750577573
Name:BOTTORF, DAVID (HA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BOTTORF
Suffix:
Gender:M
Credentials:HA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 S KIHEI RD
Mailing Address - Street 2:SUITE 225A
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8179
Mailing Address - Country:US
Mailing Address - Phone:808-875-4517
Mailing Address - Fax:
Practice Address - Street 1:1325 S KIHEI RD
Practice Address - Street 2:SUITE 225A
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8179
Practice Address - Country:US
Practice Address - Phone:808-875-4517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-16
Last Update Date:2007-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHA-184174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist