MEDICARE: DR. DEREK BOOTH DO

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	207R00000X	Internal Medicine Physician	25618	CA

General Provider Information

NPI Number	:	1699397554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEREK BOOTH DO

Provider Business Mailing Address
First Line	:	34800 BOB WILSON DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-1098
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	NAVAL MEDICAL CENTER SAN DIEGO
Second Line	:	34800 BOB WILSON DRIVE
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-5000
Country	:	US
Telephone Number	:	408-691-9354
Fax Number	:

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

Provider Enumeration Date	:	05/14/2020
Last Update Date	:	06/15/2026

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Directions to “ DR. DEREK BOOTH DO” Practice Location

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