Provider Demographics
NPI:1043322704
Name:BOTERO, MARIA L (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:BOTERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SANTALO 138-142
Mailing Address - Street 2:ESC 2 4TA-1RA
Mailing Address - City:BARCELONA
Mailing Address - State:ES
Mailing Address - Zip Code:08021
Mailing Address - Country:ES
Mailing Address - Phone:574-313-7046
Mailing Address - Fax:
Practice Address - Street 1:CRA 31 #17 SUR 61
Practice Address - Street 2:APT 1003
Practice Address - City:MEDELLIN
Practice Address - State:CO
Practice Address - Zip Code:02215
Practice Address - Country:CO
Practice Address - Phone:574-313-7046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217243207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology