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1174279905 NPI number — SHAHRAZAD LA MAE BOTELLO RDH, RDHAP

NPI Number: 1174279905
Health Care Provider/Practitioner: SHAHRAZAD LA MAE BOTELLO RDH, RDHAP

Information about “1174279905” NPI (SHAHRAZAD LA MAE BOTELLO RDH, RDHAP) exists in 1174279905 in HTML format HTML  |  1174279905 in plain Text format TXT  |  1174279905 in PDF (Portable Document Format) PDF  |  1174279905 in an XML format XML  formats.

NPI Number : 1174279905 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174279905",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOTELLO",
    "FirstName": "SHAHRAZAD",
    "MiddleName": "LA MAE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RDH, RDHAP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1ST DNBN ATTN: CREDENTIALS BOX 555221",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CAMP PENDLETON",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92055-5221",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "760-224-1659",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "31 AREA DENTAL CLINIC EDSON RANGE 310515 PHILLIPS ST.",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OCEANSIDE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92058",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "760-224-1659",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/02/2022",
    "LastUpdateDate": "03/02/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "124Q00000X",
          "TaxonomyName": "Dental Hygienist",
          "LicenseNumber": "HAP803",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "124Q00000X",
          "TaxonomyName": "Dental Hygienist",
          "LicenseNumber": "RDH28089",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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