Provider Demographics
NPI:1821675653
Name:BOTOR, FAUN LEE (MD)
Entity Type:Individual
Prefix:
First Name:FAUN
Middle Name:LEE
Last Name:BOTOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FAUN
Other - Middle Name:LEE
Other - Last Name:GINAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3014 W CHARLESTON BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-0083
Mailing Address - Country:US
Mailing Address - Phone:702-895-3011
Mailing Address - Fax:
Practice Address - Street 1:3014 W CHARLESTON BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0083
Practice Address - Country:US
Practice Address - Phone:702-895-3011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program