Healthcare Provider Details

I. General information

NPI: 1376458836
Provider Name (Legal Business Name): ROB BOTTIGGI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W WALNUT AVE
PAINESVILLE OH
44077-2928
US

IV. Provider business mailing address

200 W WALNUT AVE
PAINESVILLE OH
44077-2928
US

V. Phone/Fax

Practice location:
  • Phone: 440-392-5135
  • Fax: 440-392-5089
Mailing address:
  • Phone: 440-392-5135
  • Fax: 440-392-5089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number281627
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: