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General NPI Number Information
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NPI Number | 1790439701
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Entity Type | Individual
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Provider Name | JUAN PABLO BOTELLO MSN RN CDES
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Gender | Male
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Dates
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Enumeration Date | 02/08/2022
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 1400 E PALOMAR ST
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City | CHULA VISTA
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State | CA
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Zip | 91913-1800
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Country | US
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Telephone | 858-499-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 E PALOMAR ST
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City | CHULA VISTA
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State | CA
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Zip | 91913-1800
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Country | US
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Telephone | 858-499-2700
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 756855
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 22200760
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License Number State | CA
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