Healthcare Provider Details

I. General information

NPI: 1902726029
Provider Name (Legal Business Name): JUSTIN BOKTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10666 N TORREY PINES RD
LA JOLLA CA
92037-1027
US

IV. Provider business mailing address

8426 E HILLSDALE DR
ORANGE CA
92869-2452
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number91106
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: