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General NPI Number Information
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NPI Number | 1649375239
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Entity Type | Individual
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Provider Name | CARMEN JULIA BOTERO M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 10/16/2012
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Provider Practice Location Address
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Address Line | 5353 BALBOA BLVD STE 201
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City | ENCINO
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State | CA
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Zip | 91316-2865
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Country | US
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Telephone | 818-788-5437
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Fax | 818-788-5436
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Provider Business Mailing Address
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Address Line | PO BOX 571027
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City | TARZANA
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State | CA
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Zip | 91357-1027
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Country | US
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Telephone | 818-343-5794
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Fax | 919-343-5793
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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 | 208000000X
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Taxonomy Name | Pediatrics 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 | 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 #3
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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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