Healthcare Provider Details

I. General information

NPI: 1881006955
Provider Name (Legal Business Name): GREGORY P BOTTA M.D./PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10666 N TORREY PINES RD K323
LA JOLLA CA
92037-1027
US

IV. Provider business mailing address

FILE 57326
LOS ANGELES CA
90074-7326
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-3200
  • Fax: 858-554-3232
Mailing address:
  • Phone: 800-926-8273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA140495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: