Provider Demographics
NPI:1679768998
Name:BOTELLO, DORIS E (CPHT)
Entity type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:E
Last Name:BOTELLO
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EDIFICIO A APT. A-9
Mailing Address - Street 2:CAROLINA COURT
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982
Mailing Address - Country:US
Mailing Address - Phone:787-758-2500
Mailing Address - Fax:787-620-8197
Practice Address - Street 1:EDIFICIO A APT. A-9
Practice Address - Street 2:CAROLINA COURT
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:787-758-2500
Practice Address - Fax:787-620-8197
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2186183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2186OtherPHARMACY TECHNICIAN LIC