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NPI Code Detail

MEDICARE: LESLIE E BOTNICK M.D.

MEDICARE: LESLIE E BOTNICK M.D.
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
12085R0001XRadiation Oncology PhysicianG37645CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1WG37645DOTHERCAHC MEDICARE
4449778OTHERCOSWEDISH MEDICARE
5WG37645GOTHERCASJHC MEDICARE
6WG37645AOTHERCAPSJ MEDICARE
7WG37645KOTHERCASJO MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275530917
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE E BOTNICK M.D.
Provider Business Mailing Address
First Line : PO BOX 512185
Second Line :
City : LOS ANGELES
State : CA
Zip : 90051-0185
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5522 SEPULVEDA BLVD
Second Line :
City : SHERMAN OAKS
State : CA
Zip : 91411-3437
Country : US
Telephone Number : 818-997-1522
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 11/20/2020

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Directions to “ LESLIE E BOTNICK M.D.” Practice Location

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