Healthcare Provider Details

I. General information

NPI: 1831059526
Provider Name (Legal Business Name): CARRIE L BUTLER PHD, F(ACHI)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 VETERAN AVE RM 1-532
LOS ANGELES CA
90024-2704
US

IV. Provider business mailing address

1000 VETERAN AVE RM 1-532
LOS ANGELES CA
90024-2704
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-5631
  • Fax:
Mailing address:
  • Phone: 310-206-5631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License NumberDRK-02329383
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: