Provider Demographics
NPI:1568966562
Name:RONDEROS BOTERO, DIANA MARIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:MARIA
Last Name:RONDEROS BOTERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:DIANA
Other - Middle Name:MARIA
Other - Last Name:RONDEROS BOTERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5700 BENT PINE SQ
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-7526
Mailing Address - Country:US
Mailing Address - Phone:201-657-2731
Mailing Address - Fax:
Practice Address - Street 1:3450 11TH CT STE 306
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5012
Practice Address - Country:US
Practice Address - Phone:772-794-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL161567207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease