Active NPI
Marwan Isam Bota
- Pharmacist
- Chula Vista, CA
National Provider Identifier
1326751173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 87467
- Practice address
- 1240 Broadway
Chula Vista, CA 91911-2911 - Phone
- (619) 425-3850
- NPI assigned
- Dec 26, 2022
- Last updated
- Dec 26, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 87467 | CA | Primary |
Addresses
Primary practice location
1240 Broadway
Chula Vista, CA 91911-2911
Mailing address
10105 Greenleaf Rd
Spring Valley, CA 91977-6545
Phone (619) 888-5599
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 87467 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672012800000",
"number": "1326751173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10105 GREENLEAF RD",
"city": "SPRING VALLEY",
"state": "CA",
"postal_code": "919776545",
"telephone_number": "619-888-5599"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1240 BROADWAY",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919112911",
"telephone_number": "619-425-3850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOTA",
"first_name": "MARWAN",
"middle_name": "ISAM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-12-26",
"last_updated": "2022-12-26",
"certification_date": "2022-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "87467",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chula Vista, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.