Individual
DR. JONATHAN D BOTTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4955 VAN NUYS BLVD, SUITE 615, SHERMAN OAKS, CA 91403-1801
(818) 905-2222
(818) 905-8702
Mailing address
4955 VAN NUYS BLVD, SUITE 615, SHERMAN OAKS, CA 91403-1801
(818) 905-2222
(818) 905-8702
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A 117042
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA0572
RAILROAD
CA
Enumeration date
11/19/2008
Last updated
08/02/2012
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