MEDICARE: DR. DINA BOTROS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS55266	FL
2	183500000X	Pharmacist	75962	CA

General Provider Information

NPI Number	:	1215541297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DINA BOTROS

Provider Business Mailing Address
First Line	:	39 DIAMANTE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92620-1904
Country	:	US
Telephone Number	:	714-388-2835
Fax Number	:

Provider Business Practice Location Address
First Line	:	12025 SAN VICENTE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-4922
Country	:	US
Telephone Number	:	310-476-1237
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2020
Last Update Date	:	09/07/2020

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Directions to “ DR. DINA BOTROS ” Practice Location

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