Provider Demographics
NPI:1558119321
Name:BOTERO, ALMA
Entity type:Individual
Prefix:
First Name:ALMA
Middle Name:
Last Name:BOTERO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SE 4TH ST APT 15
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-6402
Mailing Address - Country:US
Mailing Address - Phone:914-247-9061
Mailing Address - Fax:
Practice Address - Street 1:116 SE 4TH ST APT 15
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-6402
Practice Address - Country:US
Practice Address - Phone:914-247-9061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-339980106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician