Healthcare Provider Details

I. General information

NPI: 1609712512
Provider Name (Legal Business Name): DONAVIN LEVON BUTLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43845 10TH ST W STE 2B
LANCASTER CA
93534-4800
US

IV. Provider business mailing address

43845 10TH ST W STE 2B
LANCASTER CA
93534-4800
US

V. Phone/Fax

Practice location:
  • Phone: 661-940-9094
  • Fax:
Mailing address:
  • Phone: 661-940-9094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: