Provider Demographics
NPI:1548482722
Name:BOTTEGA, VALERIE C (RD, CDE)
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:C
Last Name:BOTTEGA
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CUMMINGS RD
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-2915
Mailing Address - Country:US
Mailing Address - Phone:732-274-8863
Mailing Address - Fax:
Practice Address - Street 1:11 CUMMINGS RD
Practice Address - Street 2:
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852-2915
Practice Address - Country:US
Practice Address - Phone:732-274-8863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ708647133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered