Provider Demographics
NPI:1861769143
Name:BOTELLO, MICHAELA NICOLE (BA)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:NICOLE
Last Name:BOTELLO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15022 AVENIDA MONTUOSA
Mailing Address - Street 2:UNIT F
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-1436
Mailing Address - Country:US
Mailing Address - Phone:858-837-0815
Mailing Address - Fax:
Practice Address - Street 1:15022 AVENIDA MONTUOSA
Practice Address - Street 2:UNIT F
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-1436
Practice Address - Country:US
Practice Address - Phone:858-837-0815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program