Individual
MARC I BOTNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
18133 VENTURA BLVD STE 102, TARZANA, CA 91356-3641
(424) 314-7695
(424) 314-7699
Mailing address
4140 W 190TH ST, TORRANCE, CA 90504-5513
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
A72882
CA
2085R0001X
Radiation Oncology Physician
Primary
A72882
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A728820
—
CA
Enumeration date
11/25/2005
Last updated
06/01/2022
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