Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Issa M Botros, MD

Individual provider Adult Medicine Physician · NPI 1124227772

Dr. Issa M Botros, MD is a Family Practice in San Pedro, California. Qualified in 1987, 39 years ago. Practices with Providence Medical Institute, a 336-clinician group and accepts Medicare assignment. Licensed in California and Michigan.

Years since qualifying
39
Licensed in
CA, MI
In the registry since
2007
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1499 W 1st St
San Pedro, CA 90732-3255
Phone: (310) 241-2590
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Adult Medicine Physician (primary) Taxonomy 207QA0505X · Licence A106987 (CA)
Adult Medicine Physician Taxonomy 207QA0505X · Licence 4301090843 (MI)

Record details

NPI number1124227772
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 13, 2007
Last updated in NPPESNovember 30, 2021
Certification dateNovember 30, 2021
Mailing address1499 W 1st St, San Pedro, CA 90732-3255

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 1987 (39 years in practice)
Group practice Providence Medical Institute — 336 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare