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General NPI Number Information
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NPI Number | 1770685968
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Entity Type | Organization
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Legal Business Name | NEUROCENTER MEDICAL CLINIC INC
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 25485 MEDICAL CENTER DR #108
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City | MURRIETA
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State | CA
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Zip | 92562-6900
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Country | US
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Telephone | 951-696-1818
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Fax | 951-696-2939
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Provider Business Mailing Address
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Address Line | P.O BOX 2770
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City | TEMECULA
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State | CA
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Zip | 92593-2770
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Country | US
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Telephone | 951-696-1818
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Fax | 951-696-2939
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAJA B BOUTROS
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Credential | M.D.
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Telephone | 951-696-1818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | F43949
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License Number State | CA
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