Provider Demographics
NPI:1609290915
Name:BOTELLO, GEORGE (ASSOCIATES)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:BOTELLO
Suffix:
Gender:M
Credentials:ASSOCIATES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E EARLL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2647
Mailing Address - Country:US
Mailing Address - Phone:575-623-1480
Mailing Address - Fax:575-622-3325
Practice Address - Street 1:1010 S GARDEN AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-6866
Practice Address - Country:US
Practice Address - Phone:575-623-1480
Practice Address - Fax:575-622-3325
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker