Individual
DR. ADEL BOUTROS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
22611 LAKE FOREST DR, LAKE FOREST, CA 92630-1700
(949) 951-9399
(949) 951-9403
Mailing address
PO BOX 8095, FOUNTAIN VALLEY, CA 92728-8095
(949) 951-9399
(949) 951-9403
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A47792
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A477921
—
CA
01
—
A47792
STATE LICENSE
CA
Enumeration date
11/28/2006
Last updated
07/09/2007
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