Healthcare Provider Details

I. General information

NPI: 1134205529
Provider Name (Legal Business Name): HEATHER L BUTLER MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST STE 164
PASADENA CA
91106-2405
US

IV. Provider business mailing address

960 E GREEN ST #164
PASADENA CA
91106-2401
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-7790
  • Fax: 626-793-9018
Mailing address:
  • Phone: 626-793-7790
  • Fax: 626-793-9018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG30345
License Number StateCA

VIII. Authorized Official

Name: DR. HEATHER LEE BUTLER
Title or Position: OWNER
Credential: MD
Phone: 626-793-7790