Provider Demographics
NPI:1538217211
Name:BOTELLO, BEATRIZ Y
Entity type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:Y
Last Name:BOTELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 SE FIR ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OR
Mailing Address - Zip Code:97391-1828
Mailing Address - Country:US
Mailing Address - Phone:541-336-1542
Mailing Address - Fax:
Practice Address - Street 1:36 SW NYE ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-3821
Practice Address - Country:US
Practice Address - Phone:541-265-6611
Practice Address - Fax:541-574-6252
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator