MEDICARE: YOHANA BOTERO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1023662749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOHANA BOTERO

Provider Business Mailing Address
First Line	:	5707 N 22ND ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-4350
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6620 NORTH NEBRASKA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604
Country	:	US
Telephone Number	:	813-955-2114
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2019
Last Update Date	:	08/02/2019

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Directions to “ YOHANA BOTERO ” Practice Location

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