Botnick, Marc I

Botnick, Marc I is an individual health care provider with primary practice located at 18133 Ventura Blvd Ste 102 , Tarzana CA 91356-3641. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Radiation Oncology. Allopathic & Osteopathic Physicians / Radiation Oncology is his primary health care specialty. Botnick, Marc I can be contacted via phone (424) 314-7695.

Contact Information

Primary practice address
18133 Ventura Blvd Ste 102 Tarzana CA 91356-3641
Phone: (424) 314-7695
Fax: (424) 314-7699
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X A72882 California
Allopathic & Osteopathic Physicians / Radiation Oncology 2085R0001X A72882 California

Profile Details

NPI number 1033192844
LBN Legal business name Botnick, Marc I
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 25th, 2005
Last updated Jun 1st, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033192844 NPPES
California MEDICAID 00A728820

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