| Jason K Boutros M D Inc | |
|
2750 E Washington Blvd Suite 260 Pasadena CA 91107-1448 | |
| (626) 798-8923 | |
| (626) 798-0258 |
| Full Name | Jason K Boutros M D Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2750 E Washington Blvd, Pasadena, California |
| Authorized Official Name and Position | Cindy Chon (ADMINISTRATOR) |
| Authorized Official Contact | 6267988923 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jason K Boutros M D Inc 2750 E Washington Blvd Suite 260 Pasadena CA 91107-1448 Ph: (626) 798-8923 | Jason K Boutros M D Inc 2750 E Washington Blvd Suite 260 Pasadena CA 91107-1448 Ph: (626) 798-8923 |
| NPI Number | 1053532580 |
|---|---|
| Provider Enumeration Date | 05/01/2007 |
| Last Update Date | 01/28/2011 |
| Medicare PECOS PAC ID | 4284539594 |
|---|---|
| Medicare Enrollment ID | O20031201000293 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053532580 | NPI | - | NPPES |
| GR0076360 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A42891 (California) | Primary |
| Provider Name | Jason K Boutros |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942243563 PECOS PAC ID: 5496656241 Enrollment ID: I20040120000580 |
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