Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 1034153 | TX |
NPI | 1003495912 |
---|---|
Provider Name | Bryan Botello |
First Address | El Paso, TX 79902-1124 |
Second Address | El Paso, TX 79902-1123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2021 |
Last Update Date | 07/04/2021 |