Individual
DR. JASON K BOUTROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2554 E WASHINGTON BLVD, STE A, PASADENA, CA 91107-1445
(626) 798-8923
(626) 798-0258
Mailing address
2554 E WASHINGTON BLVD, STE A, PASADENA, CA 91107-1445
(626) 798-8923
(626) 798-0258
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A42891
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A42891
—
CA
01
—
A42891
LICENSE NO.
CA
Enumeration date
06/13/2006
Last updated
02/02/2017
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