Individual provider · Type 1 NPI
Mary Boutros
Gerontology Nurse Practitioner · Los Angeles, CA
NPI number
1982588976
Active
Practice location
11301 Wilshire Blvd
Los Angeles, CA 90073-1003
Mailing address
3080 Charlotte St
Newbury Park, CA 91320-4451
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Gerontology Nurse Practitioner Primary | 363LG0600X | 95036011 (CA) |
Gerontology Nurse Practitioner: Definition to come...
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About NPI 1982588976
Mary Boutros's National Provider Identifier is 1982588976, issued on Aug 2, 2025. The primary taxonomy on file is Gerontology Nurse Practitioner (363LG0600X), and the practice location is in Los Angeles, CA. The record was last updated on Aug 2, 2025.