Healthcare Provider Details

I. General information

NPI: 1912833120
Provider Name (Legal Business Name): ALISHA VERONICA BOTELLO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4119 BRANDON AVE
BROOMFIELD CO
80020-7906
US

IV. Provider business mailing address

4119 BRANDON AVE
BROOMFIELD CO
80020-7906
US

V. Phone/Fax

Practice location:
  • Phone: 720-885-6769
  • Fax:
Mailing address:
  • Phone: 720-885-6769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1702014
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: