Provider Demographics
NPI:1427373307
Name:BOTOLIN, DANIELA (MD)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:BOTOLIN
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 1:6071 E WOODMEN RD STE 340
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2612
Mailing Address - Country:US
Mailing Address - Phone:719-591-8100
Mailing Address - Fax:719-591-8101
Practice Address - Street 1:6071 E WOODMEN RD STE 340
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2612
Practice Address - Country:US
Practice Address - Phone:719-591-8100
Practice Address - Fax:719-591-8101
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0056249208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17175054Medicaid