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General NPI Number Information
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NPI Number | 1134464852
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Entity Type | Individual
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Provider Name | MYRA BOTELLO M.A.
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Gender | Female
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 12501 IMPERIAL HWY STE 400
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City | NORWALK
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State | CA
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Zip | 90650-1419
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Country | US
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Telephone | 562-807-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 9137 BROOKSHIRE AVE
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City | DOWNEY
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State | CA
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Zip | 90240-2910
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Country | US
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Telephone | 562-457-7268
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 102534
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License Number State | CA
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