Botello, Gina

Botello, Gina is an sole proprietor health care provider with primary practice located at 1896 E Babbit Ln , San Luis AZ 85349. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Botello, Gina can be contacted via phone (928) 722-6112.

Contact Information

Primary practice address
1896 E Babbit Ln San Luis AZ 85349
Phone: (928) 722-6112
Fax: (928) 722-6113
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X AP5180 Arizona
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X AP5180 Arizona

Profile Details

NPI number 1770917429
LBN Legal business name Botello, Gina
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 29th, 2013
Last updated Dec 23rd, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770917429 NPPES
Arizona Other Z176616 MEDICARE PTAN
Arizona MEDICAID 004882 MEDICARE PTAN

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