1679768998 NPI number — MRS. DORIS E BOTELLO CPHT

Table of content: MRS. DORIS E BOTELLO CPHT (NPI 1679768998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679768998 NPI number — MRS. DORIS E BOTELLO CPHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOTELLO
Provider First Name:
DORIS
Provider Middle Name:
E
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679768998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
EDIFICIO A APT. A-9
Provider Second Line Business Mailing Address:
CAROLINA COURT
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-758-2500
Provider Business Mailing Address Fax Number:
787-620-8197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIFICIO A APT. A-9
Provider Second Line Business Practice Location Address:
CAROLINA COURT
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-758-2500
Provider Business Practice Location Address Fax Number:
787-620-8197
Provider Enumeration Date:
09/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183700000X , with the licence number:  2186 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2186 . This is a "PHARMACY TECHNICIAN LIC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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