Active NPI
Luisa Fernanda Olano Botero, DDS
- Dentist
- Victorville, CA
National Provider Identifier
1689705071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 50965
- Practice address
- 13790 Bear Valley Road
Victorville, CA 92392 - Phone
- (760) 955-2273
- NPI assigned
- Mar 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 50965 | CA | Primary |
Addresses
Primary practice location
13790 Bear Valley Road
Victorville, CA 92392
Mailing address
11450 Church St
# 60
Rancho Cucamonga, CA 91730
Phone (909) 556-4386
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50965 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Euclid Avenue Dental Inc | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Upland, CA
- NPI 1023818358
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642032000000",
"number": "1689705071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11450 CHURCH ST",
"address_2": "# 60",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "91730",
"telephone_number": "909-556-4386"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13790 BEAR VALLEY ROAD",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "92392",
"telephone_number": "760-955-2273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLANO BOTERO",
"first_name": "LUISA",
"middle_name": "FERNANDA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-08",
"last_updated": "2022-01-13",
"certification_date": "2022-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "50965",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Victorville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.