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NPI Code Detail

MEDICARE: FABIAN BOUTROS OTIENO MD

MEDICARE: FABIAN BOUTROS OTIENO MD
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
1390200000XStudent in an Organized Health Care Education/Training ProgramBP10098178TX

General Provider Information

NPI Number : 1982540340
Entity Type Code : Individual
Provider Name (Legal Business Name) : FABIAN BOUTROS OTIENO MD
Provider Business Mailing Address
First Line : 1700 E SAUNDERS ST
Second Line :
City : LAREDO
State : TX
Zip : 78041-5474
Country : US
Telephone Number : 956-796-5000
Fax Number :
Provider Business Practice Location Address
First Line : 1700 E SAUNDERS ST
Second Line :
City : LAREDO
State : TX
Zip : 78041-5474
Country : US
Telephone Number : 95-679-6500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2026
Last Update Date : 04/28/2026

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Directions to “ FABIAN BOUTROS OTIENO MD” Practice Location

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