Manal Monique Boutros, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A042963 Issued in CA

Practice address

1425 S Mariposa Ave
#104
Los Angeles, CA 90006-4300

Phone

(323) 734-3411

Fax

(323) 734-3411

NPI assigned

Nov 16, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1195171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195171200000",
    "number": "1275714339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 S MARIPOSA AVE",
            "address_2": "#104",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900064300",
            "telephone_number": "323-734-3411",
            "fax_number": "323-734-3411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 S MARIPOSA AVE",
            "address_2": "#104",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900064300",
            "telephone_number": "323-734-3411",
            "fax_number": "323-734-3411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTROS",
        "first_name": "MANAL",
        "middle_name": "MONIQUE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-16",
        "last_updated": "2007-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A042963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tal Boussi
• Christine Nathalie Bouteiller, PHD
• Ronald Charles Boutelle, PHD, PSYD
• Curtis P Bouton, P.T.
• Leticia Rodriguez Boutros, PNP
• Mary Boutros
• Hania Adib Bouz
• David Bow
• Nicole Bowden, COTA
• Michael Eugene Bowdish, M.D.

• Family Medicine Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 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.