Healthcare Provider Details

I. General information

NPI: 1598780769
Provider Name (Legal Business Name): JENNIFER R BUTLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

101 THE CITY DR S
ORANGE CA
92868-3201
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7733
  • Fax:
Mailing address:
  • Phone: 714-456-7733
  • Fax: 714-456-7180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number200501527
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberC127796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: