Provider Demographics
NPI:1710191374
Name:BOTERO, SARA MARTA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MARTA
Last Name:BOTERO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SARA
Other - Middle Name:MARTA
Other - Last Name:LLANES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3700 SW 110TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3540
Mailing Address - Country:US
Mailing Address - Phone:305-226-5319
Mailing Address - Fax:305-226-5319
Practice Address - Street 1:9380 SW 72ND ST STE B120
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5456
Practice Address - Country:US
Practice Address - Phone:305-274-3172
Practice Address - Fax:305-274-4831
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT 249106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist