Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 558683 | CA |
NPI | 1013083120 |
---|---|
Provider Name | Mr. Alvaro Gonzales Botello |
First Address | Long Beach, CA 90813-3408 |
Second Address | Long Beach, CA 90813-3408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 24/05/2011 |