Healthcare Provider Details

I. General information

NPI: 1710841366
Provider Name (Legal Business Name): MONICA ROCIO BOTELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 S BRAND BLVD
SAN FERNANDO CA
91340-4002
US

IV. Provider business mailing address

1335 N HOLMES AVE
ONTARIO CA
91764-2534
US

V. Phone/Fax

Practice location:
  • Phone: 818-898-0223
  • Fax:
Mailing address:
  • Phone: 323-376-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: