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General NPI Number Information
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NPI Number | 1538130653
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Entity Type | Individual
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Provider Name | JOSEPH BOTTALICO D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 01/05/2016
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Provider Practice Location Address
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Address Line | 420 E 6TH ST SUITE 202
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City | ODESSA
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State | TX
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Zip | 79761-4529
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Country | US
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Telephone | 432-582-8757
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Fax | 432-582-8928
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Provider Business Mailing Address
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Address Line | PO BOX 4123
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City | ODESSA
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State | TX
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Zip | 79760-4123
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Country | US
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Telephone | 432-582-2277
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Fax | 432-333-2802
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MB04176800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | MB04176800
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | OS005732L
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | P1969
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License Number State | TX
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