Peter Botros, DO

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

License

20A22840 Issued in CA

Practice address

1612 N Moore LN
Clovis, CA 93619-2002

Phone

(321) 800-5569

NPI assigned

Apr 5, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 23, 2026 through Mar 23, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1617580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726704000000",
    "number": "1508445768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1612 N MOORE LN",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936192002",
            "telephone_number": "321-800-5569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1612 N MOORE LN",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936192002",
            "telephone_number": "321-800-5569"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20900 Biscayne Blvd",
            "address_purpose": "LOCATION",
            "city": "Aventura",
            "state": "FL",
            "postal_code": "331801495",
            "country_code": "US",
            "telephone_number": "305-692-3325",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4351 E Lohman Ave Ste 300",
            "address_purpose": "LOCATION",
            "city": "Las Cruces",
            "state": "NM",
            "postal_code": "880118262",
            "country_code": "US",
            "telephone_number": "575-556-7600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOTROS",
        "first_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-05",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "CA",
            "license": "20A22840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Norman D Bontogon, CRNA
• Sydney Breana Boolootian I
• Melanie Boone, NP
• Stacy Marie Borchardt, LMFT
• Daniel Borgstadt, M.D.
• Fouad Boulbol
• Anne Vinhan Boulom, RPH
• David Bowen, AU.D
• Ashley S Bowers, NP
• Mariam Boyajian

• Neuromusculoskeletal Medicine & OMM Physician in Clovis, CA
• Providers in Clovis, CA by specialty
• Neuromusculoskeletal Medicine & OMM Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.