Organization
CARMEN BOTERO, MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN HALE (BUSINESS OFFICE MANAGER)
(208) 762-6836
Entity
Organization
Contact information
Practice address
18321 CLARK ST, TARZANA, CA 91356-3501
(208) 676-9080
Mailing address
PO BOX 570587, TARZANA, CA 91357-0587
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
A47742
CA
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
A47742
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A477420
—
CA
01
—
ZZZ01458Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
04/24/2007
Last updated
09/11/2025
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