Individual
DR. RAJA B BOUTROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
25485 MEDICAL CENTER DR, #208, MURRIETA, CA 92562
(951) 696-1818
(951) 696-2939
Mailing address
P.O BOX 2770, TEMECULA, CA 92593-2770
(951) 696-1818
(951) 696-2939
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
A499730
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A499730
BLUE CROSS ID#
CA
05
—
0693834
—
CA
01
—
90050380
PACIFICARE ID#
CA
01
—
GR0091910
MEDICAL GROUP #
CA
Enumeration date
09/06/2006
Last updated
07/09/2007
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