Provider Demographics
NPI:1013083120
Name:BOTELLO, ALVARO GONZALES (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:ALVARO
Middle Name:GONZALES
Last Name:BOTELLO
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1045 ATLANTIC AVE SUITE 715
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3408
Mailing Address - Country:US
Mailing Address - Phone:562-983-5496
Mailing Address - Fax:562-432-1864
Practice Address - Street 1:1045 ATLANTIC AVE SUITE 715
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3408
Practice Address - Country:US
Practice Address - Phone:562-983-5496
Practice Address - Fax:562-432-1864
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA558683363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics