Organization
NEUROCENTER MEDICAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAJA B BOUTROS M.D. (OWNER)
(951) 696-1818
Entity
Organization
Contact information
Practice address
25485 MEDICAL CENTER DR, #108, MURRIETA, CA 92562-6900
(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
F43949
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0693834
MEDICAL ID #
CA
01
—
90050380
PACIFICARE ID#
CA
01
—
930048312
RAILROAD MEDICARE #
CA
05
—
GR0091910
—
CA
01
—
ZZZ094462
BLUE CROSS GROUP ID #
CA
Enumeration date
09/01/2006
Last updated
08/02/2022
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