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NPI Code Detail

MEDICARE: JENNIFER BOTELHO PA-C

MEDICARE: JENNIFER BOTELHO PA-C
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
1363AS0400XSurgical Physician AssistantPA00838OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2191806OTHERORDOLI
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891782751
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER BOTELHO PA-C
Provider Business Mailing Address
First Line : 1130 NW 22ND AVE STE 535
Second Line :
City : PORTLAND
State : OR
Zip : 97210-2976
Country : US
Telephone Number : 503-274-4999
Fax Number :
Provider Business Practice Location Address
First Line : 1130 NW 22ND AVE STE 535
Second Line :
City : PORTLAND
State : OR
Zip : 97210-2976
Country : US
Telephone Number : 503-274-4999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2005
Last Update Date : 08/26/2011

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Directions to “ JENNIFER BOTELHO PA-C” Practice Location

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