MEDICARE: BOTANO TECHNOLOGIES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1003643370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOTANO TECHNOLOGIES, LLC

Provider Business Mailing Address
First Line	:	5 ISLAND AVE
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-1364
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 ISLAND AVE
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-1364
Country	:	US
Telephone Number	:	516-589-4146
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CETIN AMATO
Credential	:
Telephone Number	:	516-589-4146

Provider Enumeration Date	:	09/19/2024
Last Update Date	:	09/19/2024

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