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General NPI Number Information
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NPI Number | 1063631802
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Entity Type | Organization
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Legal Business Name | CARMEN BOTERO, MD
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 18321 CLARK ST
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City | TARZANA
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State | CA
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Zip | 91356-3501
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Country | US
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Telephone | 208-676-9080
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 570587
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City | TARZANA
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State | CA
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Zip | 91357-0587
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | KAREN HALE
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Credential |
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Telephone | 208-762-6836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | A47742
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | A47742
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License Number State | CA
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