Individual
MARY BOUTROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11301 WILSHIRE BLVD, LOS ANGELES, CA 90073-1003
(310) 478-3711
Mailing address
3080 CHARLOTTE ST, NEWBURY PARK, CA 91320-4451
(805) 807-0743
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
95036011
CA
Other
Enumeration date
08/02/2025
Last updated
08/02/2025
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