Nancy Mary Boutros, DDS DOCTOR OF DENTAL

Primary specialty

DentistTaxonomy code 122300000X

License

42809 Issued in CA

Practice address

1381 E Las Junas Dr
Suite #8
San Gabriel, CA 91776

Phone

(626) 614-5800

Fax

(626) 614-9570

NPI assigned

Jan 11, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Nancy Mark Youssef Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063562072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 10TH ST",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "90402",
            "telephone_number": "310-393-2054",
            "fax_number": "310-393-2054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1381 E LAS JUNAS DR",
            "address_2": "SUITE #8",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "91776",
            "telephone_number": "626-614-5800",
            "fax_number": "626-614-9570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTROS",
        "first_name": "NANCY",
        "middle_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "DDS DOCTOR OF DENTAL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "42809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NANCY",
            "last_name": "YOUSSEF",
            "middle_name": "MARK",
            "prefix": "DR.",
            "credential": "DDS DOCTOR OF DENTAL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Iliana Borquez Corona
• Boston Medical Group California LLC
• Sawsan Nosshi Boutros, DDS
• William B Brady, DDS MS
• Michelle Brenhaug
• Brian Wu MD PHD Inc
• Leilani Brown

• Dentist in San Gabriel, CA
• Providers in San Gabriel, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.