Individual
BOTOND A VITA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2115 STUART AVE, ALAMOSA, CO 81101-2269
(719) 589-8091
(719) 589-8112
Mailing address
106 BLANCA AVE, ALAMOSA, CO 81101-2340
(719) 589-3000
(719) 587-1372
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
00380
WV
363A00000X
Physician Assistant
Primary
2460
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
56582722
—
CO
01
—
840255530069
ROCKY MTN HEALTH PLANS
CO
01
—
VIVI2460
ANTHEM BC/BS
CO
Enumeration date
09/15/2006
Last updated
08/14/2013
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