Individual
GINA BOTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2851 S AVENUE B BLDG 19, YUMA, AZ 85364-7726
(928) 336-2090
(928) 722-6113
Mailing address
2400 S AVENUE A, YUMA, AZ 85364-7170
(928) 344-2000
(928) 336-1395
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
AP5180
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP5180
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004882
—
AZ
01
—
Z176616
MEDICARE PTAN
AZ
Enumeration date
08/29/2013
Last updated
11/15/2024
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