Provider Demographics
NPI:1174754352
Name:BOTELHO, MARCIO
Entity type:Individual
Prefix:MR
First Name:MARCIO
Middle Name:
Last Name:BOTELHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E SHAW AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7621
Mailing Address - Country:US
Mailing Address - Phone:559-221-8100
Mailing Address - Fax:559-221-8101
Practice Address - Street 1:114 E SHAW AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7621
Practice Address - Country:US
Practice Address - Phone:559-221-8100
Practice Address - Fax:559-221-8101
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)