Provider Demographics
NPI:1649375239
Name:BOTERO, CARMEN JULIA (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:JULIA
Last Name:BOTERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 571027
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-1027
Mailing Address - Country:US
Mailing Address - Phone:818-343-5794
Mailing Address - Fax:919-343-5793
Practice Address - Street 1:5353 BALBOA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2865
Practice Address - Country:US
Practice Address - Phone:818-788-5437
Practice Address - Fax:818-788-5436
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA47742208000000X, 2080P0202X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine