Individual
MARIANA MEJIA BOTERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6 BASSWOOD RD, PARAJE, NM 87007-1004
(505) 431-0711
Mailing address
PO BOX 549, PARAJE, NM 87007-0549
(505) 431-0711
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2016-0719
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78721016
—
NM
05
—
H3451
—
NM
Enumeration date
06/03/2010
Last updated
04/19/2021
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