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General NPI Number Information
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NPI Number | 1457618001
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Entity Type | Individual
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Provider Name | TREVOR L BOTTORFF LAADC, CSC
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Gender | Male
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 04/20/2012
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Provider Practice Location Address
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Address Line | 976 LENZEN AVENUE ROOM 4
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City | SAN JOSE
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State | CA
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Zip | 95126
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Country | US
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Telephone | 408-792-5274
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Fax | 408-947-8719
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Provider Business Mailing Address
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Address Line | 976 LENZEN AVE RM 4
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City | SAN JOSE
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State | CA
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Zip | 95126-2737
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Country | US
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Telephone | 408-792-5274
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Fax | 408-947-8719
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | A4650709
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License Number State | CA
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