Basic Information
| Provider Information | |||||||||
| NPI: | 1962956805 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOTERO MARQUEZ PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 36680 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850676680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022341991 | ||||||||
| FaxNumber: | 6022343748 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 W CLARENDON AVE STE 142 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850133449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022341803 | ||||||||
| FaxNumber: | 6022343748 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2016 | ||||||||
| LastUpdateDate: | 08/09/2016 | ||||||||
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| AuthorizedOfficialLastName: | TARQUINO | ||||||||
| AuthorizedOfficialFirstName: | MARIO | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6022341803 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 42734 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.