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Individual

LESLIE E BOTNICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
5522 SEPULVEDA BLVD, SHERMAN OAKS, CA 91411-3437
(818) 997-1522
Mailing address
PO BOX 512185, LOS ANGELES, CA 90051-0185

Taxonomy

Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
G37645
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00G376450
CA
01
449778
SWEDISH MEDICARE
CO
01
654518
SWEDISH MEDICAID
CO
01
WG37645A
PSJ MEDICARE
CA
01
WG37645D
HC MEDICARE
CA
01
WG37645G
SJHC MEDICARE
CA
01
WG37645K
SJO MEDICARE
CA
Enumeration date
07/07/2005
Last updated
11/20/2020
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