Healthcare Provider Details

I. General information

NPI: 1366548372
Provider Name (Legal Business Name): SUZANNE RACHELLE BUTALA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20701 BEACH BLVD #277
HUNTINGTON BEACH CA
92648-4908
US

IV. Provider business mailing address

19121 BEACH BLVD
HUNTINGTON BEACH CA
92648-2307
US

V. Phone/Fax

Practice location:
  • Phone: 714-661-8439
  • Fax:
Mailing address:
  • Phone: 714-848-1522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPF4529
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number256495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: